Minutes Confirmed on April 12, 2021

This meeting of the Board of Health was held by electronic means and the proceedings of the Board of Health were conducted publicly.

These measures were necessary to comply with physical distancing requirements and as civic buildings were closed to the public.

The Board of Health recommends that:

1.  City Council request the Ontario Ministry of Labour, Training and Skills Development to continue to provide additional resources and funding for enforcing the Reopening Ontario Act and other workplace safety regulations in Toronto workplaces that will provide ongoing safer working environments beyond the COVID-19 pandemic.

2.  City Council request the Ontario Ministry of Labour, Training and Skills Development to continue to undertake ongoing enforcement blitzes of Toronto workplaces to ensure compliance with public health measures and requirements set out in the Reopening Ontario Act.

The Board of Health considered Items HL26.1 and HL26.7 together.

The Board of Health:

1.  Requested the Government of Ontario to increase vaccine supply to the City of Toronto to ensure that the allocation of COVID-19 vaccine doses to Public Health Units accounts for the local proportion of priority groups under each phase of Ontario's COVID-19 Vaccination Plan, including the commuting working population; Public Health Units with higher rates of COVID-19 transmission; as well as the increased capacity for jurisdictions like Toronto to deliver vaccines rapidly to the population.

2.  Requested the Government of Ontario to continue to support Toronto Public Health's strategy for the collection of socio-demographic data by including socio-demographic indicators as part of the Provincial COVID-19 vaccination tracking system (COVaxON).

3.  Requested the Government of Ontario to support Toronto Public Health's data strategy by including a socio-demographic questionnaire in the Provincial COVaxON system to be given to a random sample of individuals, including the following questions:

a.  born in Canada; if not, how long resided in Canada;

b.  gender identity;

c.  sexual orientation;

d.  disability;

e.  medical risk factors;

f.  occupation; and

g.  employment status (COVID-19-specific).

4.  Requested the Government of Ontario to publicly share the disaggregated socio-demographic data on COVID-19 immunizations collected in Parts 2 and 3 with Toronto Public Health and the broader public.

5.  Requested the Ontario Ministry of Labour, Training and Skills Development to continue to provide additional resources and funding for enforcing the Reopening Ontario Act and other workplace safety regulations in Toronto workplaces that will provide ongoing safer working environments beyond the COVID-19 pandemic.

6.  Requested the Ontario Ministry of Labour, Training and Skills Development to continue to undertake ongoing enforcement blitzes of Toronto workplaces to ensure compliance with public health measures and requirements set out in the Reopening Ontario Act.

7.  Requested the Medical Officer of Health to report to the May 10, 2021 meeting of the Board of Health (or earlier) on the current Provincial strategy to establish an up-to-date protocol for the physical movement of long-term care home residents who have received the necessary vaccine and, in particular, to clarify the essential public health procedures needed to enable long-term care home residents to travel outside of their facilities, either alone or accompanied.

8.  Requested the Medical Officer of Health, in consultation with the City Solicitor, the Chief People Officer, and the Executive Director, Social Development, Finance and Administration, to review the legislative authority, as well as the policy and public health context, for both the Government of Ontario and the City of Toronto to consider the possibility and advisability of requiring COVID-19 vaccination for employees in some occupations, as a condition of their employment in front-line positions, in circumstances where such a requirement could significantly reduce an identifiable risk to vulnerable persons in their care or to other employees or members of the public and to report to the June 14, 2021 meeting of the Board of Health, including an examination of the following:

a.  the legal jurisdiction;

b.  implications for the equity and sovereignty of groups that have been disproportionately affected by the pandemic, along with those who have low levels of trust in health care and public health grounded in historic and present mistreatment by institutions; and

c.  precedents from comparable jurisdictions, if available.

9.  Reaffirmed that a comprehensive approach to reducing the disproportionate impact of COVID-19 on Indigenous, Black, and racialized Torontonians, including newcomers, must be central to COVID-19 immunization planning and:

a.  requested the Government of Ontario to continuously evaluate the effectiveness of the Provincial implementation of the Government of Ontario's Ethical Framework for COVID-19 Vaccine Prioritization, such as ensuring the equitable geographic distribution of pharmacy-based immunizations; and

b.  requested the Medical Officer of Health to continue to provide advice to the Government of Ontario and the City of Toronto on reducing the disproportionate impact of COVID-19 on Indigenous, Black, and racialized Torontonians, including newcomers, through COVID-19 immunizations.

10.  Requested the Medical Officer of Health, in consultation with the City Manager and the Fire Chief and General Manager, Emergency Management, and Toronto's COVID-19 Incident Commander, to:

a.  support Indigenous-led immunization efforts in Toronto, including Anishnawbe Health Toronto, Auduzhe Mino Nesewinong, and Native Child and Family Services of Toronto; and

b.  make available City of Toronto resources, such as funding, in-kind support, and communications, as required, to support Indigenous-led immunization efforts.

11.  Requested the Chair to write to the Chair, Civic Appointments Committee, to convey the Board's desire that its membership include voices from local Indigenous communities during the next recruitment of Board Directors and in the event of any vacancies.

The Medical Officer of Health and the Associate Medical Officer of Health, Incident Management System COVID-19 Pandemic Response, gave a presentation on Response to COVID-19: March 2021 Update.

The Director, Community Resources, Social Development, Finance and Administration, gave a presentation on Board of Health Update: Community Engagement and Mobilization Plan.

This report provides an update on the COVID-19 pandemic locally and the COVID-19 vaccination plan. It also provides an update on Toronto Public Health's (TPH) response to COVID-19 outbreaks in workplaces, including posting information about outbreaks online and strengthening public health measures through a Class Order under Section 22 of the Health Protection and Promotion Act.

Until March 7, 2021, Toronto was subject to the provincial Stay-at-Home Order and was in the "Shutdown Zone" of the Province's Reopening Ontario Act, Ontario Regulation (O. Reg.) 82/20. On March 8, 2021, the Province moved Toronto into the Grey-Lockdown level. Although cases in the second wave peaked on January 10, 2021, COVID-19 infection remains a risk to residents as the virus continues to circulate and many residents still do not have immunity.  

A growing proportion of the COVID-19 cases are variants of concern. COVID-19 variants of concern are more transmissible and are appearing in settings across Toronto, including long-term care homes, hospitals, schools, shelters and workplaces.  

TPH's focus continues to be mitigating impacts of COVID-19 variants with appropriate public health measures and vaccinating all Toronto residents who wish to be vaccinated as supply becomes more available.

The City of Toronto is prepared to roll out vaccines to all Toronto residents to protect them from COVID-19 infection. This includes the coordination of immunization clinics offered by other health sector agencies across the city, and readying nine City of Toronto-operated COVID-19 mass-immunization clinics. The COVID-19 Immunization Task Force (ITF) is working to ensure all nine City-operated clinics will be ready to open once the Province provides its registration and booking system and sufficient vaccine supply.

The Board of Health:

1.  Approved the changes to the administration of the Toronto Urban Health Fund Program, including the Toronto Urban Health Fund Review Panel and the Toronto Urban Health Fund Indigenous Review Panel, in the report (March 8, 2021) from the Medical Officer of Health.

2.  Approved the revised Terms of Reference for the Toronto Urban Health Fund Review Panel in Attachment 1 and the revised Terms of Reference for the Toronto Urban Health Fund Indigenous Review Panel in Attachment 2 to the report (March 8, 2021) from the Medical Officer of Health.

This report provides the Board of Health with an overview of proposed changes to the Toronto Urban Health Fund (TUHF) program administration.

TUHF program administration is supported by two Board of Health committees: the TUHF Review Panel and the TUHF Indigenous Review Panel. Toronto Public Health's TUHF program supports the recruitment of review panel members and recommends the members to the Board of Health for the Board to appoint to the TUHF review panels. The City Clerk's Office administers the meetings of the review panels.

The City of Toronto recently implemented an online grant management system. First piloted in 2018, and phased over the last several years, the Toronto Grants, Rebates and Incentives Portal (TGRIP) is an end-to-end system with robust features to manage and administer granting programs such as TUHF. The new TGRIP system presents an opportunity to review and improve operational efficiencies in the administration of the TUHF program and the review panel process.

This report is intended to propose changes to the process of appointing TUHF review panel members to address recruitment challenges and to adopt the TGRIP for the administration of the TUHF.

The Board of Health:

1.  Acknowledged the Government of Ontario for the approximately $3 million committed toward the extra costs faced by student nutrition programs in Toronto during the COVID-19 pandemic and reiterated its request to the Government of Ontario to provide adequate funding to fully stabilize student nutrition programs for remote learners for the current school period to June 2021.

2.  Acknowledged the Department of Agriculture and Agri-Food Canada for its announcement on December 18, 2020 in support of breakfast programs nationally and requested the Department of Agriculture and Agri-Food Canada and Breakfast Club of Canada to expedite and provide more details on Toronto's share of the funding allocation.

This report responds to a motion passed at the January 18, 2021 Board of Health meeting requesting the Medical Officer of Health to report on the status of additional emergency pandemic funding for student nutrition from the Province of Ontario at the March 22, 2021 Board of Health meeting.

Student nutrition programs contribute to the health and wellbeing of students through providing nutritious food choices and have been demonstrated to improve learning outcomes among children. Toronto Public Health continues to monitor the evolving COVID-19 situation with schools and works with student nutrition programs, school boards and their foundations to ensure the safe operation of student nutrition programs.

The Board of Health:

1.  Received the report (March 8, 2021) from the Medical Officer of Health for information.

This report provides the Board of Health with an update on the risk management reporting that is part of the Ontario Public Health Accountability Framework requirements where public health units are required to annually report on a Risk Management Plan to the Ministry of Health.

The Board of Health:

1.  Received the report (March 8, 2021) from the Medical Officer of Health for information.

This report provides an update to the Board of Health on the Toronto Public Health 2021 Capital Budget and 2022-2030 Capital Plan as approved by City Council on February 18, 2021.

The Board of Health:

1.  Received the report (March 9, 2021) from the Medical Officer of Health for information.

This report provides the Board of Health with an update on the Toronto Public Health 2021 Operating Budget approved at the City Council meeting of February 18, 2021.

In November 2020, the Board of Health recommended a 2021 Operating Budget of $344,596.4 thousand gross and $127,383.9 thousand net. Decisions made during the subsequent 2021 municipal budget process are outlined in this report.

City Council approved a Toronto Public Health 2021 Budget Committee Recommended Operating Budget of $344,744.2 thousand gross and $124,391.4 thousand net. The Council Approved Budget provides an increase of $64,073.3 thousand gross (22.8 per cent increase in gross expenditures) and $53,562.3 thousand net (75.6 per cent increase in net expenditures) over the 2020 Approved Operating Budget.

The Board of Health:

1.  Reaffirmed support for Dr. Eileen de Villa, Medical Officer of Health, City of Toronto, and the entire team at Toronto Public Health and recognized their tireless work in the response to the COVID-19 pandemic.

2.  Continued to support a public health-informed approach to Toronto's response to the COVID-19 pandemic that is grounded in data, evidence, and the best advice of our public health experts.

The Board of Health considered Items HL26.1 and HL26.7 together.

Through each stage of the COVID-19 pandemic, we have been guided by clear advice from our public health experts. For over a year now, our Medical Officer of Health, Dr. Eileen de Villa, and her team at Toronto Public Health, have worked tirelessly to protect the health of all Torontonians.

I know that the weight of this responsibility has not been easy to bear. Dr. de Villa and her team have had to make very difficult recommendation to this Board, to City Council, and to our inter-governmental partners – recommendations that have at times been unpopular, and resulted in personal accusations and cruel attacks.

But it's these very recommendations that have helped protect countless people, and saved lives.

Toronto has not been immune to COVID-19. To date, 2,743 people have lost their lives – a devastating total. Many more have been hospitalized, and have had their lives deeply disrupted by this virus. But through swift action and public health direction, we have managed to prevent our city from becoming New York – or Italy or Brazil. This is a credit to Dr. de Villa's commitment to treating our city, and everyone in it, as though it were her own patient, and to the round-the-clock work of our public health team.

Through Dr. de Villa's leadership, and through the support of this Board, we have developed a response that is grounded in equity. Toronto Public Health was one of the first public health units to collect disaggregated data on COVID-19 and race and income, in order to see how this virus was impacting different communities. With Toronto Public Health's support, our city developed the first municipal COVID-19 Equity Action Plan in the country, to increase resources and supports to communities hit hardest by the pandemic. Toronto Public Health's COVID-19 Dashboard has provided Torontonians with transparent, accessible data, including information on variants of concern and workplace outbreaks. And Dr. de Villa's leadership and dedication has been evident in every single one of the City's COVID-19 Briefings, where she has spoken clearly and with great empathy to Torontonians about what we need to do to protect ourselves and others.

People in our city are tired, and they want the pandemic to be over. But the reality is that COVID, and the highly-transmissible variants of concern, still pose a great threat. We can't let our guard down now – we have to continue to stay vigilant, and follow the advice of our public health experts.

With this in mind, I am recommending that the Board of Health make clear our support for our Medical Officer of Health, and our continued insistence on a pandemic response that is informed by public health advice and expertise.

The Board of Health:

1.  Acknowledged and affirmed the important contributions made by the Toronto Food Policy Council and the Toronto Food Policy Council's own call for a full renewal and anti-racist analysis.

2.  Requested the Medical Officer of Health to approach the Executive Director, Social Development, Finance and Administration, about the possibility of providing a one-time grant from the Community Partnership Investment Program to the Toronto Food Policy Council to sustain their work through 2021, preferencing Black, Indigenous, and People of Colour for leadership roles in paid position(s), in order to advance a full renewal and revitalization process for the Toronto Food Policy Council.

3.  Requested the Medical Officer of Health, in consultation with the Executive Director, Social Development, Finance and Administration, and in alignment with the work led by the Confronting Anti-Black Racism Unit, to include in the upcoming report on the creation of the City of Toronto's Black Food Sovereignty Plan options for resources and staffing support tied specifically and adequately to Black-led food sovereignty leadership, infrastructure, and capacity.

4.  Requested the Medical Officer of Health, in consultation with the Executive Director, Social Development, Finance and Administration, to undertake consultations with food policy, food security, and food systems stakeholders, including current and former members of the Toronto Food Policy Council, and make recommendations to the December 6, 2021 meeting of the Board of Health on:

a.  an optimal advisory model for the Toronto Food Policy Council and its relationship to the City of Toronto and City Council decision-making;

b.  sustainable resourcing options to support the work of the Toronto Food Policy Council under the recommended model; and

c.  alignment with the City's recovery and rebuild efforts in the areas of food security and food equity to advance the development of sustainable food systems, in alignment with municipal and international commitments (the Food Charter, the Food Lens, the Milan Food Policy Pact, and the C40 Good Food Pledge).

The Toronto Food Policy Council (TFPC) is a true success story for our city. It was 30 years ago this year that the TFPC was established as an advisory body for the Board of Health. In that time, hundreds of dedicated volunteers have worked with City staff and the Board to advance critical projects like the Toronto Food Charter and Food Strategy. The TFPC built capacity and connections across organizations and over the years has supported countless food solutions to the complex challenges facing too many Torontonians.

However, this past year has been exceptionally challenging for the TFPC, exacerbated by years of diminishment of funding and of allocation of resources to strategic alignment of food systems. When Toronto Public Health (TPH) made the difficult decision to redeploy all of their staff to the COVID-19 response, staff who normally support the TFPC were reassigned to other work as the focus of the organization had to be placed on responding to the public health crisis. In recognition of the importance of the food strategy, TPH temporarily assigned two of its food strategy staff to the Social Development, Finance and Administration Division (SDFA) to support the COVID-19 emergency and recovery food response, and this work continues. Like so many others, the volunteer members of the TFPC also had to manage tremendously difficult circumstances created by the pandemic for their organizations and their families.

The pandemic has highlighted and worsened the inequities that already existed in our city, and made the work of the TFPC all the more important for both the COVID-19 response as well as planning for recovery. Simultaneously, this period has also brought forward structural inequities within the TFPC. Following calls to action by Black members of the Council, the TFPC as a whole has called for "a process of internal reckoning and anti-racist analysis" recognizing a traditionally white-centric leadership that must change.

In this context, the inability for the City to provide formal staff support for the TFPC has become increasingly unsustainable. I want to thank every TFPC volunteer member for their dedication to food solutions, equity, and justice this past year – not just through the TFPC, but in their communities and across the entire city.

There is an urgent need to address the issues that the TFPC brought to my attention in their letter on March 8th, 2021. Resources must be restored to the TFPC - and these must first be tied to the renewal process called for by the Council, and re-establish an advisory model that can continue to support the food system and anti-racism work.

The most urgent priority of the TFPC is to confirm a permanent paid, and well-resourced staff position devoted to food and health issues and priorities of Black, Indigenous, and People of Colour (BIPOC). As the Board of Health prepares to receive a report on Black Food Sovereignty this spring, this recommendation from the TFPC must be integrated along with the full report.

There is a great deal of work to be done as we continue to respond to the pandemic, in the planning for recovery from COVID-19, and in our continuous commitment to improve public health through the social determinants of health across Toronto. Staff will be reporting back on Black Food Sovereignty later in the spring, and there will be an update on activities associated with the Milan Urban Food Policy Pact, the C40 Good Food Cities Declaration, and the World Resource Institute's Cool Food Pledge before summer.

I have prepared these recommendations in close consultation and with advice from TPH and SDFA staff. Immediate one-time funding will stabilize the TFPC for 2021, and City staff will undertake consultations this year on ways to strengthen the role of the TFPC going forward.

Announcements

The Chair acknowledged that the Board of Health was meeting on the traditional territory of many nations including the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Haudenosaunee and the Wendat peoples and is now home to many diverse First Nations, Inuit and Métis peoples. The Chair also acknowledged that Toronto is covered by Treaty 13 with the Mississaugas of the Credit.

Councillor Gord Perks, the Medical Officer of Health, and the Chair recognized Susan Shepherd, Manager, Toronto Drug Strategy Secretariat, Toronto Public Health, for her work and leadership, as she is retiring from the City of Toronto in March 2021.

Where the Directors of the Board of Health listed in the attendance for this meeting participated remotely, they were counted for quorum as permitted by Section 189(4.2) of the City of Toronto Act, 2006, and the Board's Procedures.