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.

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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).

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Declarations of Interest under the Municipal Conflict of Interest Act

Confirmation of Minutes - February 10, 2025

Speakers/Presentations - The speakers list will be posted online at 8:30 a.m. on April 1, 2025

Communications/Reports

The Acting Medical Officer of Health recommends that:

1. The Board of Health request the Medical Officer of Health to report back to the Board with an update on Toronto Public Health’s Indigenous Health Strategy progress by Q1 2026.

2. The Board of Health request the Acting Medical Officer of Health to share this report with the City of Toronto Indigenous Affairs Office and Social Development, Finance and Administration Division to demonstrate how the work of the Indigenous Wellness Committee aligns with the City of Toronto Reconciliation Action Plan’s Strategic Action #13.

In April 2023, the Medical Officer of Health provided an update to the Board of Health on developing a mental health and addictions strategy for the City of Toronto. At that time, the Board of Health recommended that the Medical Officer of Health co-develop a parallel strategy with Indigenous organizations and communities to ensure that approaches and actions support the unique needs of urban Indigenous people living in Toronto.

In response to this recommendation, Toronto Public Health staff co-hosted two Indigenous Wellness Roundtables with the Toronto Aboriginal Social Supports Council in October 2023, to determine next steps with Indigenous organizations. The main recommendation was to establish an Indigenous Wellness Committee, co-led by Toronto Public Health and Indigenous organizations.

This report provides a progress update on the work of the Indigenous Wellness Committee and includes recommendations to the Board of Health for continued communication about Toronto Public Health’s Indigenous Health Strategy.

There is no financial impact associated with the adoption of the recommendation in this report.

The Acting Medical Officer of Health recommends that:

1. The Board of Health request the Acting Medical Officer of Health to continue to collaborate with Divisions, public health agencies, academic institutions, and community researchers as appropriate, on initiatives to better understand environmental exposure risks in Toronto such as:

a. Exploring collaborative research opportunities to update information on the air pollution burden of illness, including cancer.

b. Continuing participation as a knowledge user in the Study of Winter Air Pollution in Toronto (SWAPIT) and other air quality studies to inform local policies and action.

c. Undertaking an assessment of the quality improvement options for optimizing the ChemTRAC program's operations and effectiveness.

2. The Board of Health request the Acting Medical Officer of Health to continue contributing to environmental carcinogen risk reduction through provision of public health technical expertise to the City of Toronto or other levels of government on relevant initiatives.

3. The Board of Health request the Acting Medical Officer of Health to continue amplifying messages about relevant environmental carcinogens through participation in initiatives of other agencies or City divisions to reduce public health risks of environmental cancers.

Cancer-causing agents in the environment, or environmental carcinogens, contribute to some of the most common cancers in Ontario. Some carcinogens are in the environment from human activities (for example, pollution from cars or industry) while others are part of the natural environment (for example, radon and solar radiation). The severity and frequency of exposures to environmental cancer-causing agents are potentially modifiable. Some environmental exposures can be outside the control of individuals.

The burden of environmental cancers is felt across the city. As a public health unit, Toronto Public Health (TPH) has a role in environmental cancer prevention and in reducing exposures at the community level. Toronto Public Health contributes to community cancer prevention and exposure reduction by working with other levels of government and partners, and by taking action within local public health's scope and mandate. Toronto Public Health's prevention activities include increasing public awareness of primary cancer prevention, responding to public complaints, participating in research studies, enforcing existing laws, and advocating for laws to prevent exposures to environmental carcinogens.

Occupational cancers are related to workplace exposures. The hierarchy of hazard controls is a framework for actions to help protect worker health and safety in workplaces.  Many provincial laws exist to protect workers from occupational exposures to hazards.   

This report highlights Toronto Public Health's participation in existing strategies to prevent cancer. The report also identifies opportunities to enhance multi-level government efforts to reduce the burden of cancer from environmental and occupational carcinogens in Toronto.

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 Acting Medical Officer of Health recommends that:  

1. The Board of Health request the Medical Officer of Health collaborate with Municipal Licensing and Standards to assess changes made through the Implementation Review of the Noise By-law in Item EC9.5 that is intended to minimise the health impacts of noise.

Noise is raised by Toronto residents as an issue of concern. To address this concern, the City of Toronto has many initiatives guided by the 2019 Noise Action Plan and the updated City of Toronto Noise By-law. Toronto Public Health’s (TPH) mandate is determined by the Ontario Public Health Standards. Noise is not described as an environmental health hazard in the Ontario Public Health Standards. Toronto Public Health consults and provides advice to other City divisions in their work to mitigate the impacts of excessive noise. 

The 2019 Noise Action Plan contains recommended actions within the authority of each City division to reduce excessive noise in Toronto. Although the COVID-19 pandemic resulted in pauses to some City operations, Toronto Public Health and other City divisions have since made substantial progress in the Noise Action Plan. For example, Municipal Licensing and Standards completed the Noise By-law Review in 2024 in consultation with Toronto Public Health, other City divisions, and stakeholders. The review identified new efforts to mitigate noise in Toronto.  

This report, as requested by City Council through Item 2024.EC9.5, Implementation Review of the Noise By-law, provides an updated review of the health impacts of noise. The latest research continues to describe excessive noise exposure impacts on cardiovascular, cognitive, sleep, and mental health outcomes. These are smaller relative impacts than other environmental and social determinant of health factors on these outcomes. This means that while there is evidence to support links between excessive noise and adverse health impacts on individuals, the population-level impact of noise is limited relative to other factors that cause population morbidity and mortality.

There are no financial impacts associated with the recommendations of 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 Acting Medical Officer of Health recommends that:  

1. The Board of Health receive this report for information.

This report provides an update on the Toronto Public Health 2025 Operating Budget considered by City Council on February 11, 2025.

City Council considered a 2025 Toronto Public Health Operating Budget of $288,575.6 thousand gross, $85,705.5 thousand net and 1,884 Full-Time Equivalent positions. The City approved Operating Budget reflects an increase of $2,677.5 thousand gross, $2,836.8 thousand net, and a reduction of twenty-four (24) positions compared with Board of Health recommendations. The City approved Operating Budget represents an increase of $3,145.4 thousand gross (1.1 percent increase) and $6,000.0 thousand net (7.5 percent) over the 2024 Approved Operating Budget.

There is no financial impact associated with the recommendation of this report 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 Acting Medical Officer of Health recommends that:  

1. The Board of Health receive this report for information.

This report provides an update on the City approved Toronto Public Health 2025 Capital Budget and 2026-2034 Capital Plan. The City approved Toronto Public Health 2025 Capital Budget is $4,130 thousand for four (4) projects with future year commitments of $10,023 thousand, totaling $14,153 thousand. The City approved 2026-2034 Capital Plan has two (2) projects totaling $7,999 thousand in the Toronto Public Health 2026-2034 Capital Plan.

Key changes between the Board of Health recommended 2025 Capital Budget and 2026-2034 Capital Plan and the City approved 2025 Capital Budget and 2026-2034 Capital Plan are:

• Adding a new project, Homelessness and Addiction Recovery Treatment (HART) Hubs
• Postponing the Digital Strategy project  
• Carrying over cash flow from 2024

There is no financial impact associated with the recommendation of this report 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 Acting Medical Officer of Health recommends that:

1. The Board of Health receive this report for information.

This report provides an update to the Board of Health on the Toronto Public Health Operating Budget for the year ending on December 31, 2024.

As of December 31, 2024, Toronto Public Health's 2024 approved Operating Budget was $285,430.2 thousand gross and $79,705.5 thousand net. As of December 31, 2024, Toronto Public Health’s gross expenditures were underspent by $37,571.3 thousand (13.2 percent) and revenue was underachieved by $25,369.2 thousand (12.3 percent), resulting in a net variance of $12,202.1 thousand (15.3 percent). The favorable net variance of $12,202.1 thousand was primarily driven by salary and benefits underspending from a slower restart of paused mandatory Ministry of Health cost-shared programs and salary savings. This report is based on the City's 2024-2025 funding agreement with the Ministry of Health, ending on March 31, 2025. The 2025-2026 funding agreement with the ministry is still being finalized.

There is no financial impact associated with the recommendation of this report 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 Acting Medical Officer of Health recommends that:  

1. The Board of Health receives this report for information.

This report provides an update to the Board of Health on the Toronto Public Health Capital Budget Variance for the year ending on December 31, 2024.

As of December 31, 2024, Toronto Public Health spent $4,232.1 thousand representing 66.3 percent of the 2024 Approved Capital Budget of $6,379.5 thousand.

Through the 2025 Budget process, $1,570.5 thousand of Toronto Public Health's 2024 Approved Capital Budget has been carried forward and included in Toronto Public Health's 2025 Approved Capital Budget, based on Toronto Public Health's projection at Q3 2024. With 2024 year-end actual capital spending, Toronto Public Health's carry forward is finalized at $1,646.4 thousand. Toronto Public Health is working to analyze any incremental carry forward for the Inspection Management Implementation project and will request to adjust previously approved carry forward once analysis is finalized.

There is no financial impact associated with the recommendation of this report 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.

Councillor Chris Moise recommends that:

1.The Board of Health receives this for information.

Last December, the Government of Ontario passed the Community Care and Recovery Act, requiring five Supervised Consumption Service (SCS) sites and Consumption and Treatment Services (CTS) sites in Toronto to close their doors no later than March 31, 2025.

Alongside these legislative changes, the provincial government also announced a new funding stream to support the creation of Homelessness and Addiction Recovery Treatment (HART) Hubs, including a total of $378 million to implement these hubs across Ontario.

The new Homelessness and Addiction Recovery Treatment (HART) Hub model will help address the needs of our most vulnerable communities, offering a comprehensive suite of supports, which can include, addiction care, primary care, supportive housing, employment support, and more.

As part of the Homelessness and Addiction Recovery Treatment (HART) Hub announcement, Supervised Consumption Service sites impacted by the new legislation were encouraged to apply for funding, with an aim to transition their services to the new model.

In response, Toronto Public Health (TPH) and partners across City divisions, healthcare, and community organizations submitted a Downtown Homelessness and Addiction Recovery Treatment (HART) Hub application to the Ministry of Health. The Ministry approved this application ‘in principle’ on January 2, 2025.

The City of Toronto’s Downtown Homelessness and Addiction Recovery Treatment (HART) Hub application outlines a range of proposed services that could be implemented pending suitable funding. These include 24/7 Intake, Medical Monitoring and Referrals. Supportive Housing Connection, Substance Use Treatment and Primary Care, Outpatient Medical Specialty Services, Assertive Community Therapy, Withdrawal Management Beds, and more.

Toronto Public Health has been working with partners to develop and implement plans for year one of the Hub, with some services initiating on April 1, and more becoming available throughout the year.

As we work to mitigate the impacts of the March 31 closures of Supervised Consumption Service sites and continue collaborating with our partners to establish our own Downtown Homelessness and Addiction Recovery Treatment (HART) Hub, I am requesting an update be provided to the Board of Health.

Councillor Chris Moise recommends that:

1. Re-open Item HL13.7, titled "Hiring Process for the Next Medical Officer of Health".

2. Delete Part 1 of its decision on Item HL13.7 and adopt the following:

Establish a Medical Officer of Health Hiring Panel composed of the Chair, the Vice-Chair, and two citizen members of the Board of Health, and the Mayor.

3. Delete Part 2 of its decision on HL13.7 and adopt the following:

Appoint the following to the Medical Officer of Health Hiring Panel:

Director Chris Moise

Director Alejandra Bravo

Director Stephanie Zhou

Director Abinaya Chandrabalan

Mayor Olivia Chow

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

At our meeting on May 24, 2024, we struck a hiring panel to lead the hiring process. Phelps Group was selected to assist with the process and a search was carried out through the end of 2024. The hiring panel has now reconvened and has decided to restart the hiring process with an enhanced compensation package, which was approved by the Ministry, with the goal of reaching a broader pool of applicants.

As Deputy Mayor Amber Morley is no longer a member of the Board of Health, the hiring panel is now constituted by the following voting members:

• Councillor Chris Moise (Chair)
• Mayor Olivia Chow
• Councillor Alejandra Bravo
• Director Abinaya Chandrabalan
• Director Stephanie Zhou

Throughout the process, the hiring panel may engage with the Deputy City Manager, Community and Social Services, the City Manager’s office and the Ministry of Health in an advisory capacity.

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

• March - April: Candidate Outreach
• April 28 - May 2: Long List Definition
• May 5-9: First Round Interviews
• May 12-16: Second Round Interviews
• June 3: Medical Officer of Health Appointment at Board of Health
• June 25: Medical Officer of Health Appointment Approval at City Council
• June 27: 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.

Councillor Chris Moise recommends that:

1. The Board of Health receives this for information.

There have been recent developments on the Legal Challenge of the Community Care and Recovery Act, so I would like for us to receive an update from Toronto Public Health Staff.