Agenda

Members of the Board and Staff: Please keep this agenda and the accompanying material until the City Council meeting dealing with these matters has ended.

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toronto.ca/council

This agenda and any supplementary materials submitted to the City Clerk can be found online at www.toronto.ca/council. Visit the website for access to all agendas, reports, decisions, and minutes of City Council and its Committees. Items with original signatures are kept on file with the City Clerk's Office and are available for viewing.

Declarations of Interest under the Municipal Conflict of Interest Act

Confirmation of Minutes - February 25, 2019

Speakers/Presentations - A complete list will be distributed at the meeting

Communications/Reports

Gayle Bursey, Director, Healthy Public Policy, and Interim Director, Chronic Disease and Injury Prevention, Toronto Public Health, will give a presentation on Heat Relief Services Update.

The Medical Officer of Health recommends that:

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

On February 26, 2019, the Deputy Premier and Minister of Health and Long-Term Care announced an Ontario strategy that includes legislative, operational, and policy changes to how the provincial health care system is currently managed and delivered.

This report is in response to a City Council request on February 26, 2019 that the Medical Officer of Health report to the April 8, 2019 Board of Health meeting on the implications of the proposed policy and legislative changes to the provincial health care system, as recently announced by the Government of Ontario.

There is no financial impact associated with this report.

The Medical Officer of Health recommends that:  

1.  The Board of Health request Health Canada to explore avenues to reduce the spread and dissemination of misinformation and false claims about vaccines.

2.  The Board of Health request the World Health Organization to consider global recommendations, similar to the WHO Framework Convention on Tobacco Control, regulating direct and indirect advertising, promotion, and sponsorship by anti-vaccine groups and anti-vaccine messages in print, audio, video, and online advertisements.

3.  The Board of Health request the following health professional organizations to educate their members on how to address vaccine hesitancy in their practices and promote vaccines: the Ontario Medical Association, the Canadian Medical Association, the Ontario Nurses' Association, the Registered Nurses’ Association of Ontario, the Canadian Nurses Association, the Ontario Pharmacists Association, the Association of Ontario Midwives, the Ontario Chiropractic Association, and the Ontario Association of Naturopathic Doctors.

4.  The Board of Health forward this report to Health Canada, Industry Canada, the Public Health Agency of Canada, the Ministry of Health and Long-Term Care, Public Health Ontario, Advertising Standards Canada, the Canadian Association of Broadcasters, the Canadian Marketing Association, the Association of Canadian Advertisers, Public Health Ontario, the Ontario Public Health Association, the Association of Local Public Health Agencies, the Council of Ontario Medical Officers of Health, the Ontario Medical Association, the Canadian Medical Association, the Ontario Nurses' Association, the Registered Nurses’ Association of Ontario, the Canadian Nurses Association, the Ontario Pharmacists Association, the Association of Ontario Midwives, the Ontario Chiropractic Association, and the Ontario Association of Naturopathic Doctors.

Vaccine hesitancy is the reluctance or refusal to vaccinate despite the availability of vaccines. It is a growing concern internationally and has been identified as a top ten threat to global health by the World Health Organization. In Canada, an estimated 20 percent of parents are vaccine hesitant and are unsure about the safety and effectiveness of vaccines.

Social media and the internet play a significant role in spreading misinformation about vaccines and have contributed greatly to vaccine hesitancy. Technology companies such as Pinterest, Facebook, Instagram, and Google have acknowledged the detrimental role that these platforms have played in spreading misinformation about vaccines, and have taken some action to address this issue. 

Clear and truthful messages supporting vaccines and the importance of immunization in protecting health are critical to combatting vaccine hesitancy. This report provides a number of recommended actions to help address this growing concern and the role the federal government, as well as international, national, and provincial organizations can play to support these efforts.

There is no financial impact associated with this report.

The Medical Officer of Health recommends that:  

1.  The Board of Health, in recognition of the strong and growing evidence that increasing access to alcohol is associated with health and social harms, reaffirms its previous recommendations, including the development of a provincial alcohol strategy to mitigate alcohol-related harms in Ontario.

2.  The Board of Health forward this report to Ontario's Chief Medical Officer of Health, the Association of Local Public Health Agencies, the Council of Ontario Medical Officers of Health, the Centre for Addiction and Mental Health, the Ontario Public Health Association, the Alcohol and Gaming Commission of Ontario, the Ministry of Health and Long-Term Care, the Ministry of Finance, the Ministry of the Attorney General, and the Ministry of Community Safety and Correctional Services.

Alcohol consumption remains a leading risk factor for acute harms and chronic disease in Canada. Though the proportion of Ontario adults consuming alcohol has remained stable over the past two decades, the amount of alcohol consumed per person has increased significantly. In particular, average weekly consumption among women has increased by 90 percent between 1996 and 2017. Serious concerns related to this increase and to the social acceptance of alcohol consumption were raised by Canada's Chief Public Health Officer in the 2018 Report on the State of Public Health in Canada.

An emerging issue is the increase in access to alcohol that started in 2014. Evidence has shown that increasing the availability of alcohol (for example, adding more access points, extending the hours of sale and service, or lowering purchase price) is associated with increased alcohol consumption and alcohol-related health and social harms.

This report provides an update on the health impacts of alcohol consumption, describes recent changes to where and how alcohol is accessed, and presents evidence on mitigation measures. The evidence presented reaffirms previously adopted Board of Health recommendations for the Government of Ontario to proactively balance the provision of alcohol with the need to mitigate health and social harms.

There is no financial impact associated with this report.

The Medical Officer of Health recommends that:

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

Toronto Public Health's (TPH) inspection staff conduct Infection Prevention and Control (IPAC) inspections at approximately 1,050 licensed child care centres annually under the Infection Prevention and Control Protocol, 2018 of the Ontario Public Health Standards. Effective July 1, 2018, the Ministry of Health and Long-Term Care added a new requirement through the Infection Prevention and Control Disclosure Protocol, 2018 that all IPAC inspections of licensed child care centres be made available online on the Board of Health's website.

This staff report provides an overview of TPH's actions towards fulfilling this new requirement of the Ontario Public Health Standards.

There is no financial impact associated with this report.

The Medical Officer of Health recommends that:  

1.  The Board of Health appoint the 14 candidates listed in Confidential Attachment 1 to the Toronto Food Policy Council for a term of office ending December 31, 2021, and until successors are appointed.

2.  The Board of Health authorize the public release of the names and biographies in Confidential Attachment 1, once Recommendation 1 of this report is adopted by the Board of Health.

The Toronto Food Policy Council (TFPC) was created as a Subcommittee of the Board of Health (BOH) in 1991 to keep Toronto Public Health (TPH) and the BOH abreast of emerging policy issues, trends, challenges, and possibilities related to fostering an equitable, sustainable food system.

This report provides an update on the membership for, and recommends appointments to, the TFPC.

There is no financial impact associated with this report.

The Medical Officer of Health recommends that:

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

This report provides the Board of Health (BOH) with an update on the Toronto Public Health (TPH) 2019 Operating Budget which was approved at the City Council meeting on March 7, 2019.

In November 2018, the BOH recommended a 2019 Operating Budget of $257,012.0 thousand gross and $65,364.8 thousand net that included two reduction options and 10 proposals for new and enhanced services. Decisions made during the subsequent 2019 City Budget process are outlined in this report.

City Council approved a TPH 2019 Budget Committee Recommended Operating Budget of $255,279.2 thousand gross and $64,498.8 thousand net. The Council Approved Budget provides an increase of $417.6 thousand gross (0.2 percent increase in gross expenditures) and $702.1 thousand net (1.1 percent increase in net expenditures) over the 2018 Approved Operating Budget.

There is no financial impact associated with this report.

The 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 2019 Capital Budget and 2019-2028 Capital Plan, as approved by City Council on March 7, 2019.

There is no financial impact associated with this report.

Councillor Joe Cressy recommends that:

1.  City Council request the Province of Ontario to reinstate funding for supervised consumption services at Street Health and St. Stephen's Community House and to maintain funding for Toronto Public Health's The Works.

2.  The Board of Health request the Medical Officer of Health to engage with the Federal Government on support for supervised consumption services in Toronto.

The overdose crisis is the defining health issue of our time. In both our city and our province, the number of people dying from opioid overdoses continues to rise. Recent data from the Coroner shows that in 2017, 308 people in Toronto died from opioid overdoses. This represents a 66 percent increase from 2016, and a 125 percent increase from 2015. Preliminary data from the Coroner for the first nine months of 2018 there were 193 deaths from opioids. This number is expected to rise as cause of death is determined in more cases. Just last month, the city saw 22 people die from suspected opioid overdose, with over 450 additional paramedic calls for suspected non-fatal opioid overdoses, the most since Toronto Public Health began reporting this data in August 2017. The situation remains urgent, and we need to do everything possible to save lives.

Late last year, the provincial government introduced new regulations for supervised consumption services in Ontario, and announced a cap on the number of sites in the province of 21. Although there were concerns with the restrictive nature of the new Consumption and Treatment Service guidelines, the acknowledgement of the role of harm reduction services within the new framework was critical. At that time, the Board of Health formally requested that the Province maintain funding for all existing supervised injection and overdose prevention sites in the Toronto.

On the afternoon of March 29, without prior notice, the Provincial Government announced only 15 of the 21 supervised injection and overdose prevention sites in Ontario had been approved for funding under the new regulations. The six sites not approved include three in Toronto, and three in London and Ottawa. Two overdose prevention sites in our city - Street Health at Dundas and Sherbourne and St. Stephen's Community House – were informed their funding would end abruptly two days later, along with their legal ability to operate. The third Toronto site not formally approved – Toronto Public Health's The Works – was informed they were still under review.

Although emergency exemptions from the Federal Government were secured to ensure the continued legal operation of Street Health and St. Stephen's, both are currently operating using fundraising dollars alone. Without sustainable funding, it is possible these life-saving services could close.

The evidence is clear - supervised consumption sites save lives. At Toronto Public Health's The Works alone, there have been over 40,000 client visits and 750 overdoses reversed since they opened in August 2017 – and, demand only continues to increase. With less access to supervised consumption services, we will see more fatal overdoses in our city.

City Council has clearly articulated its support for evidence-based responses to the opioid overdose crisis, including harm reduction and supervised consumption services. In the midst of the most deadly public health crisis of our generation, we should be expanding life-saving services by opening new sites, not closing the ones we already have.