Agenda

Membership:

Councillor Chris Moise (Chair), Abinaya Chandrabalan (Vice Chair), Councillor Alejandra Bravo, Councillor Lily Cheng, Councillor Rachel Chernos Lin, Ida Li Preti, Charles Ozzoude, Councillor Anthony Perruzza, Ramanjeet Singh, Councillor Michael Thompson, Stephanie Zhou

Members of the public are invited to submit written comments or register to speak on any item listed on the agenda. For detailed information on how to participate in the Board of Health meeting, including procedures for submitting comments or requesting to speak, please visit: Have Your Say at Council & Committee Meetings (https://www.toronto.ca/city-government/council/council-committee-meetings/have-your-say/)

 toronto.ca/council

The Medical Officer of Health recommends that:  

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

This report provides highlights of Toronto Public Health's accomplishments and achievements in 2025.

The work of Toronto Public Health took place amidst evolving infectious disease threats including the largest measles outbreak in Ontario in over 25 years, rising cost of living, an ongoing drug toxicity crisis, extreme weather related to climate change, and the spread of health mis/disinformation. Despite these challenges, Toronto Public Health prioritized evidence-informed interventions, responded to health threats, and strengthened collaboration and partnerships with the community.

As Toronto Public Health experiences ongoing growth in demand for and increased complexity of its services, Toronto Public Health continues to find ways to innovate and modernize to meet the mandate of protecting the health of 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 reaffirm its commitment to advancing Indigenous health and reconciliation through public health governance and accountability mechanisms.

2.  The Board of Health request the Medical Officer of Health to report back in Q2 2027 on progress related to:

a.  continued implementation of the Indigenous Cultural Safety Action Plan;

b. Indigenous Wellness Committee deliverables, including the writing and implementation of a co-developed Indigenous Wellness Action Plan; and

c. outcomes and lessons learned from Indigenous-led partnership models, including funding, service delivery, and community governance approaches.

3.  The Board of Health authorize the Medical Officer of Health to enter into agreements and other suitable arrangements, on terms satisfactory to the Medical Officer of Health and in a form satisfactory to the City Solicitor, with Indigenous-led organizations in 2026 for the Toronto Urban Health Fund Indigenous Funding Stream, totalling $420,000 ($120k for one-year cycle and $320k for three-year cycle) and to allocate funds in alignment with the City of Toronto adopted Indigenous Funding Framework.

4.  The Board of Health request the Medical Officer of Health to provide an Indigenous cultural safety and governance learning session to Board of Health members and Toronto Public Health senior leadership in early 2027, following the confirmation of the new Board of Health membership post-elections, to ensure new and returning members are equally equipped to uphold the Board’s responsibilities to Toronto’s Indigenous community and reconciliation commitments.

This report provides the Board of Health with an update on public health actions taken to advance Indigenous health since the last comprehensive update was provided to the Board of Health in January 2024. It also outlines opportunities to strengthen and sustain this work in 2026 and beyond.

Toronto Public Health (TPH) is committed to advancing Indigenous health and wellness through culturally safe, Indigenous-informed, and community-driven public health approaches. This work supports reconciliation and responds to long-standing inequities rooted in colonization, systemic racism, and intergenerational trauma.

Toronto Public Health’s Indigenous Health Strategy is guided by the Ontario Public Health Standards, the City of Toronto Reconciliation Action Plan (2022–2032), the Toronto Public Health Strategic Plan’s priorities and Board of Health directives, alongside direct guidance from Indigenous service providers, Knowledge Keepers, and community leaders.

Since January 2024, Toronto Public Health has advanced key Indigenous health priorities through multiple streams of work, including Indigenous Cultural Safety implementation and learning; Indigenous mental health, wellness, and substance use response, including harm reduction; Indigenous-led vaccination and primary care partnerships; strengthening relationships and relational accountability with Indigenous partners; and advancing Indigenous health data sovereignty and governance.

There is no financial impact associated with the adoption of the recommendations in this report beyond what is included in the 2026 Operating Budget.

Funding of $420,000 for the Indigenous Funding Stream of the Toronto Urban Health Fund is included in the 2026 Operating Budget of  Toronto Public Health. The Toronto Urban Health Fund is cost-shared by the City of Toronto and the Ministry of Health.

Any future resource implications related to sustaining Indigenous-led funding models or resourcing the Indigenous Wellness Action Plan will be identified through future reporting to the Board of Health.

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 request the Medical Officer of Health to extend the Downtown Community Outreach Response and Engagement (CORE) pilot program and report back to the Board of Health in Q3 2027 with final recommendations on the program.

2. The Board of Health request the Medical Officer of Health to continue collaborating with health system partners and relevant City of Toronto divisions and agencies on initiatives to improve the health and wellbeing of people experiencing homelessness.

At the end of January 2026 there were 11,094 people experiencing homelessness in Toronto - a circumstance that can lead to extensive health harms and negatively impact the health trajectory of an individual over their lifetime. When compared to their housed counterparts, people experiencing homelessness are at increased risk of dying prematurely and suffer a higher incidence of chronic and acute health conditions including infectious disease, diabetes, cardiovascular disease and respiratory disease.

This report provides a short overview of the health impacts of homelessness and identifies key actions taken by Toronto Public Health to protect and promote the health of this population. This includes a summary of Toronto Public Health's evaluation of the Downtown Community Outreach Response and Engagement (CORE) pilot program. The Downtown CORE pilot pairs public health nurses with police constables to deliver integrated, low-barrier, mobile outreach and case management services to individuals experiencing homelessness and challenges with mental health and substance use in the Yonge-Dundas (Sankofa Square) area. The evaluation found that the program is connecting clients with medical care and social supports and identified opportunities to strengthen and refine the model. This report explores opportunities to extend this pilot program.

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

$1.3 million in gross expenditures and 8.0 positions for the Downtown CORE program are included in Toronto Public Health's 2026 Operating Budget. The program is cost-shared between the City of Toronto and Ontario's Ministry of Health.

The Medical Officer of Health will report back on next steps and any associated financial impact for the Downtown CORE program in Q3 2027.

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 receives this report for information.

This report provides an update to the Board of Health on the Toronto Public Health Operating Budget variance for the year ending on December 31, 2025.

As of December 31, 2025, Toronto Public Health's gross expenditures were underspent by $41.4 million, while revenues were underachieved by $26.2 million, resulting in a favourable net variance of $15.2 million.

As of December 31, 2025, Toronto Public Health's 2025 approved Operating Budget was $301.5 million gross and $94.0 million net. As of December 31, 2025, Toronto Public Health’s gross expenditures were underspent by $41.4 million (13.7 per cent) while revenues were underachieved by $26.2 million (12.6 percent), resulting in a net favorable variance of $15.2 million (16.0 percent). The net favorable variance was mainly driven by underspending in mandatory cost-shared programs from scaling up of redesigned programs in response to community needs and partner engagement, as well as modernizing interventions, primarily within Community Health and Wellbeing (CHW) programs.

There are no financial impacts associated with adoption 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 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 (TPH) Capital Budget variance for the year ending on December 31, 2025.

As of December 31, 2025, Toronto Public Health spent $5.551 million representing 74.9 percent of the 2025 Approved Capital Budget of $7.415 million.

As of December 31, 2025, Toronto Public Health spent $5.551 million on capital projects, representing 74.9 percent of the 2025 Approved Capital Budget of $7.415 million.

Through the 2026 Budget process, $1.656 million of Toronto Public Health's 2025 Approved Capital Budget was carried forward and included in Toronto Public Health's 2026 Approved Capital Budget, based on Toronto Public Health's projection at Q3 2025. With the confirmation of 2025 year-end actual capital spending, Toronto Public Health's carry forward is finalized at $1.802 million. Toronto Public Health is analyzing the incremental carry forward and will request an adjustment to the previously approved carry forward once the analysis is complete.

There is no financial impact associated with the adoption 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 Medical Officer of Health recommends that:  

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

This report provides an update on the Toronto Public Health 2026 Operating Budget deemed adopted by City Council on February 10, 2026.

City Council deemed adopted a 2026 Toronto Public Health Operating Budget of $307.421 million gross, $103.489 million net and 1,865.5 full-time equivalent positions. The City approved Operating Budget reflects a decrease of $8.846 million gross and $9.038 million net, and an increase of eighteen (18) positions compared with Board of Health recommendations made on September 15, 2025.

The differences are attributable to the following:

- Decrease of $9.020 million gross and net for adjustments to the phased expansion of the Student Nutrition Program and the elimination of three new positions intended to enhance the Food Safety program to support the expansion, due to budgetary constraints. 

- Increase of 19 positions for the Downtown Homelessness and Addiction Recovery Treatment (HART) Hub program, which is fully funded by the Province. 

- Increase of $0.174 million gross and decrease of $0.019 million net and increase of 2 positions for the delivery of capital projects, fully funded under Toronto Public Health's 10-Year Capital Plan.

The City approved 2026 Operating Budget represents an increase of $5.911 million gross (2.0 percent) and $9.526 million net (10.1 percent) over the 2025 approved Operating Budget.

At its meeting on February 10, 2026 City Council adopted a recommendation to authorize the City Manager and the Chief Financial Officer and Treasurer to allocate the $75.0 million in-year expenditure management target, across applicable City divisions, which will amend the Council-adopted 2026 Operating Budgets for specific divisions while maintaining the overall consolidated City Budget. A portion of this corporate affordability target will be assigned to Toronto Public Health and applied through an in-year adjustment. As a result, Toronto Public Health will receive an allocation through an in-year adjustment that will be reflected through the quarterly variance reporting process. Toronto Public Health will be required to identify savings from within its existing programs during 2026 to meet this corporate target without impacting service levels.

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 Medical Officer of Health recommends that:  

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

This report provides an update on the City approved Toronto Public Health 2026 Capital Budget and 2027-2035 Capital Plan.

The City approved Toronto Public Health 2026 Capital Budget is $8.051 million for four (4) projects with future year commitments of $2.129 million, totaling $10.180 million:

1. Electronic Medical Records (EMR) - Tuberculosis

2. Inspection Management Implementation

3. Mobile Dental Van

4. Universal Morning Meal Program (Student Nutrition Program)

The City approved Toronto Public Health 2027-2035 Capital Plan has five (5) projects totaling $17.867 million:

1. E-Consent Portal

2. Socio-Demographic Data Collection and Reporting

3. Inspection Management Program

4. Workload Management and Scheduling

5. Electronic Medical Record Profile Enhancements

Key changes between the Board of Health recommended 2026 Capital Budget and 2027-2035 Capital Plan and the City approved 2026 Capital Budget and 2027-2035 Capital Plan are:

- Transferring the Downtown Homelessness and Addiction Recovery Treatment (HART) Hub construction project to the City of Toronto's Corporate Real Estate Management (CREM) division.

- Carrying over incremental cash flow from 2025.

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 Board of Health - Performance Appraisal of the Medical Officer of Health Committee recommends that:

1. The Board of Health direct that the confidential information contained in Confidential Attachment 1 to the report (February 26, 2026) from the Medical Officer of Health remain confidential in its entirety, as it relates to personal matters about an identifiable individual, including a municipal or local board employee.

At its meeting on March 6, 2026, The Board of Health – Performance Appraisal of Medical Officer of Health considered Item HP4.1 and made recommendations to the Board of Health.

Summary from the report (February 26, 2026) from the Medical Officer of Health:

This report provides information respecting the 2025 performance appraisal for the Medical Officer of Health and objective setting for the Medical Officer of Health for 2026.

1. The Board of Health re-open Item HL30.1 - Election of Chair for 2026 - Board of Health as it pertains to the appointment end date, and delete the phrase “November 16, 2026” and replace it with “November 14, 2026” in Part 1 so it reads as follows:

1. Elected Councillor Chris Moise as Chair of the Board of Health for a term of office starting February 23, 2026 and ending November 14, 2026 and until a successor is appointed.

2. The Board of Health re-open Item HL30.2 - Election of Vice Chair for 2026 - Board of Health as it pertains to the appointment end date, and delete the phrase “November 16, 2026” and replace it with “November 14, 2026” in Part 1 so it reads as follows:

1. Elected Director Abinaya Chandrabalan as Vice Chair of the Board of Health for a term of office starting February 23, 2026 and ending November 14, 2026 and until a successor is appointed.

3.The Board of Health re-open Item HL30.3 - 2026 Board of Health Committees and Appointments as it pertains to the appointment end dates, and delete the phrase “November 16, 2026” and replace it with “November 14, 2026” in Parts 1 to 3, so they read as follows:

1. Appointed the following Board of Health directors to the Board of Health - Budget Committee for a term of office ending on November 14, 2026, and until successors are appointed:

Councillor Chris Moise

Charles Ozzoude

Ramanjeet Singh

2. Appointed the following Board of Health directors to the Board of Health - Performance Appraisal of the Medical Officer of Health Committee for a term of office ending on November 14, 2026, and until successors are appointed:

Councillor Chris Moise

Councillor Michael Thompson

Stephanie Zhou

Abinaya Chandrabalan

3. Appointed the following 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 November 14, 2026, and until a successor is appointed and pay expenses for attending alPHa's 2026 meetings and semi-annual meetings/conferences within Toronto Public Health's 2026 Approved Operating Budget:

Charles Ozzoude

At its last meeting on February 23, 2026, the Board of Health elected a Chair and Vice Chair, and made a number of appointments that end on November 16, 2026 and until successors are appointed.

It has come to my attention that the term of office for Board of Health directors ends on November 14, 2026. By re-opening these items, I am requesting that the Board of Health make a correction to the appointment end dates.

At its meeting held March 25 and 26, 2026, City Council appointed the following members to the Board of Health for a term of office ending on November 14, 2026, and until successors are appointed:

- Charna Gord; and

- Rebecca Mador

These new appointments fill the positions previously held by Suman Roy whose seat became vacant effective November 25, 2025, and Lindsay Kretchmer who submitted her resignation on November 26, 2025

Councillor Chris Moise recommends that:

1. The Board of Health request the Province of Ontario to:

a. continue funding Consumption and Treatment Services at the Moss Park (South Riverdale Community Health Centre) and Fred Victor sites; and

b. should the Consumption and Treatment Services funding be terminated, maintain provincial funding levels for these agencies to maintain their connection with their clients and provide a safe and welcoming space from which to provide:

i.  referrals to Homelessness and Addiction Recovery Treatment Hubs;
ii. onsite addiction treatment;
iii. mental health treatment;
iv. housing referrals;
v.  low barrier primary care visits;
vi. complex wound care; and
vii. food programming.

2.The Board of Health acknowledge the ongoing stigma and discrimination experienced by people who use drugs and that the closure of remaining Consumption and Treatment Services sites will impact health outcomes and access to services, and have disproportionate impacts on Indigenous, racialized and other equity-deserving populations. 

3.The Board of Health request the Ministry of Health and Health Canada ensure drug checking sample collection sites remain available to inform local drug toxicity surveillance because drug checking is the only public health surveillance method that provides timely information critical for informing overdose response and clinical care protocols, and addiction treatment plans.

4.The Board of Health endorse the letter from the Canadian Drug Policy Coalition, Drug Strategy Network of Ontario, and HIV Legal Network urging the province to reconsider the decision to defund provincially-funded supervised consumption sites in Ontario.

On March 13 the Ministry of Health notified remaining provincially-funded Consumption and Treatment Services (CTS) that they would be withdrawing their funding, effective June 13, 2026. The consumption and treatment services at Fred Victor and Moss Park will be impacted by this decision, leaving only two public sites in Toronto.

Since the Community Care and Recovery Act came into effect nearly one year ago, the City has been actively engaged in mitigating the impacts of the mass closures of Consumption and Treatment Services. I convened an interdivisional response table to ensure we are collecting the right data and approaching any challenges that arise collectively. Through the Our Health, Our City Implementation Panel we also struck a CTS Closures working group made up of community representatives from remaining Consumption and Treatment Services, Hart Hubs, advocacy groups, drop-in sites, shelters, and community health centres as well as city staff, researchers, physicians and others to better understand the impacts on the ground and develop action items related to the closures.

Consumption and Treatment Services are just one stop on the continuum of care for people who use drugs, but they are a crucial starting point for many people to eventually transition to treatment. The staff at these sites are more than just staff – for many, they are a primary source of community. When sites close, the trust that has been built over years within that community is broken and clients lose a safe place to explore recovery.

At the same time, we lose valuable information about the unregulated drug supply because many Consumption and Treatment Services also operate as sites for Toronto’s Drug Checking Service to collect samples. It is through drug checking that we can draw connections between what is in the drug supply and what we’re seeing on the streets to inform response, and, most importantly, alert the public about dangerous trends.

In response to the province’s decision, I am bringing forward the following recommendations to ensure that people who use drugs in our city are not left completely abandoned by their network of support. I hope this board will continue to stand unequivocally in support of the life-saving services so many of our residents rely upon.