Minutes Confirmed on January 17, 2022

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

These measures were necessary to comply with public health guidelines and prevent the spread of COVID-19.

The Board of Health recommends that:

1.  City Council authorize the Medical Officer of Health to negotiate, enter into, execute and extend any agreements with physicians providing medical services and advice to Toronto Public Health as part of the response to, and recovery from, the COVID-19 pandemic until December 31, 2023, on terms and conditions satisfactory to the Medical Officer of Health and in a form satisfactory to the City Solicitor.

The Board of Health considered Items HL32.1 and HL32.2 together.

The Deputy Medical Officer of Health gave a presentation on Response to COVID-19: December 2021 Update.

This report provides an update on the response to the COVID-19 pandemic as of December 2021, and responds to Board of Health direction from October 2021 to report back with a range of updates on Toronto Public Health (TPH) pandemic-related efforts.

The most recent epidemiology shows a consistent increase in the 7-day moving average number of reported daily COVID-19 cases, the reproductive number and the test positivity rate and has prompted the provincial government to pause re-opening plans. Regulations under the Reopening Ontario Act enable local health units to institute additional public health measures, if necessary, and the need for these in Toronto will be continuously reviewed.

Efforts to respond to the pandemic continue to advance on multiple fronts. Toronto Public Health continues to support school boards and schools in providing information for parents and staff about managing school attendance during the current conditions, including screening, outbreak management and vaccines. Vaccine rollout continues with third doses for eligible individuals and, with the recent approval of the COVID-19 pediatric vaccine by Health Canada, preparations are underway for vaccinating children aged 5-11 years, pending receipt of pediatric vaccine.

Toronto Public Health's pandemic response and immunization campaign has benefited from the support of additional medical expertise. Given the continuing need for this expertise, this report seeks authorization from City Council to negotiate, enter into, execute, and extend any agreements with physicians providing medical services and advice to Toronto Public Health until December 2023, as part of the response to and recovery from the COVID-19 pandemic.

The Board of Health:

1.  Received the report (November 22, 2021) from the Medical Officer of Health and the Executive Director, Social Development, Finance and Administration for information.

The Board of Health considered Items HL32.1 and HL32.2 together.

The Deputy Medical Officer of Health gave a presentation on Response to COVID-19: December 2021 Update.

The Community Immunization Engagement and Mobilization Plan is a key part of the City's COVID-19 Vaccination Program. It leverages community expertise and partnerships through Vaccine Engagement Teams to facilitate and promote equitable vaccine uptake across Toronto. Overall, the preliminary evaluation found that Vaccine Engagement Teams have been an effective strategy for increasing vaccine confidence, access, and uptake among diverse communities across Toronto, having engaged over 800,000 community members since April 2021.  

Toronto Public Health and Social Development, Finance and Administration have identified a continued need for equity-focused outreach to continue. Prioritizing of populations most impacted by COVID-19 and with lowest vaccine uptake is necessary to meet the City and the Province's 90 percent vaccine target, and to address the developing challenges associated with vaccine certification, immunization of children under the age of 12 and provision of third and booster doses to those who are eligible. Accordingly, the Community Immunization Engagement and Mobilization Plan will be extended for an additional six months, from January 1 to July 1, 2022.

The Board of Health:

Alternative Approach to the Criminalization of Drugs

1.  Reiterated its call requesting the Federal Minister of Health to use their authority under the Controlled Drugs and Substances Act to:

a.  develop a national framework to permit the simple possession of all drugs for personal use; and

 
b.  support the immediate scale up of prevention, harm reduction and treatment services.

 
2.  Directed the Medical Officer of Health to submit a request to Health Canada by the end of 2021 for an exemption under Section 56(1) of the Controlled Drugs and Substances Act, thereby starting a process to decriminalize the personal possession of illicit substances within the City of Toronto's boundaries.

3.  Requested the Medical Officer of Health, as a fundamental principle for the next steps in developing the "Toronto Model" approach to decriminalization, to continue consulting closely with people with lived and living experience of drug use, family members and community-based service providers, including Black- and Indigenous-led agencies.

Improving Access, Enhancing and Expanding Services

 
4.  Requested the Medical Officer of Health to include funding to support the Toronto Drug Strategy Secretariat in the Board of Health Recommended Toronto Public Health 2022 Operating Budget Submission for consideration in the 2022 Budget process.

5.  Requested the Medical Officer of Health to include funding to support the enhanced use of an overdose alert app in the Board of Health Recommended Toronto Public Health 2022 Operating Budget Submission for consideration in the 2022 Budget process.

6.  Requested the Federal Minister of Health to fund an expansion of injectable opioid agonist treatment (iOAT) to increase program hours and capacity to support more clients, as outlined in Item 2021.HL31.4, Toronto Public Health 2022 Operating Budget Submission.

 
7.  Requested the Provincial Minister of Health to:

a.  fund the remaining costs for the five proposals below, as outlined in Item 2021.HL31.4, Toronto Public Health 2022 Operating Budget Submission, to:

1.  increase resources for the Toronto Drug Strategy Secretariat;
 

2.  expand programming at The Works, including enhancing clinical and harm reduction services;

 
3.  improve data collection and communication to address data gaps on disparities for those disproportionately impacted by the drug poisoning crisis;

 
4.  expand overdose outreach response services outside of the shelter system to address spaces such as parks and drop-ins; and

5.  deliver mobile consumption services to address the need for supervised consumption services outside of the downtown core; and
 

b.  fund the remaining request for approximately $4 million in annualized funding to increase the capacity of several organizations that are part of the Toronto Opioid Overdose Action Network, as outlined in the proposals from the Toronto Academic Health Science Network/Toronto Public Health Opioid Task Force, to offer expanded harm reduction and treatment services that respond to the intensifying crisis.

 
8.  Reiterated its requests in Item 2021.HL29.2, Toronto Overdose Action Plan: Status Report 2021 to the Federal and Provincial Ministers of Health to address key areas of the drug poisoning crisis, including:

a.  support the domestic production of diacetylmorphine to increase the accessibility of this medication;

 
b.  remove the current cap of 21 Consumption and Treatment Services permitted in Ontario;

 
c.  reinstate funding for the Overdose Prevention Sites operated by Street Health and St. Stephen's Community House, given the urgent and ongoing need for these lifesaving health services;

 
d.  establish and fund an Urgent Public Health Need Site program for Ontario;

 
e.  increase the availability of services that support people who use methamphetamine and other stimulants;

 
f.  fund enhanced training for service providers on supporting people who use stimulants alone or with other drugs;

 
g.  support and fund the implementation of a spectrum of safer supply options, including listing injectable opioid agonist treatment (iOAT) medication on the Ontario Drug Benefit Formulary;
 

h.  expand funding for supervised consumption and other harm reduction services to better address the needs of specific groups (including Black, Indigenous and People of Colour, Two-Spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) communities), expand services across Toronto, support the provision of supervised inhalation and smoking services and allow for consumption services to remain open for longer hours;
 

i.  fund longer-term implementation of vital drug checking services and provide additional funding to create more locations in diverse settings to meet local needs;

j.  provide consistent and ongoing funding for grief and trauma supports for frontline workers responding to the drug poisoning crisis, people who use drugs and family members;
 

k.  improve employment standards for frontline harm reduction workers, including increased pay and benefits coverage, by increasing funding for supervised consumption and other harm reduction services; and
 

l.  fund a comprehensive Substance Use Crisis Centre in Toronto.

The Board of Health considered Items HL32.3 and HL32.4 together.

The Medical Officer of Health gave a presentation on Actions to Respond to the Drug Poisoning Crisis in Toronto.

The status quo approach to the drug poisoning crisis is not working. There is an urgent need for a comprehensive public health approach to drug policy that removes structural barriers to healthcare and social services, provides alternatives to the toxic drug supply, and enhances and expands services to improve the health and well-being of Toronto's communities.

Toronto continues to be in the midst of a drug poisoning crisis, exacerbated by the COVID-19 pandemic. Data shows 531 confirmed opioid toxicity deaths among residents of Toronto in 2020, an 81 per cent increase compared to 2019. From November 1, 2020 to October 31, 2021, Toronto Paramedic Services responded to 5,776 suspected opioid overdose calls, including 351 calls involving death. This is a 61 per cent increase in the number of suspected opioid overdose calls compared to the previous 12-months, and a 53 per cent increase in the number involving a death. Fatal and non-fatal overdoses continue to increase, which are attributed to the unpredictable and toxic nature of the unregulated drug supply, as well as pandemic-related service reductions and physical distancing requirements.

Toronto Public Health is leading City efforts and working with other City divisions and community partners to implement the Toronto Overdose Action Plan to prevent and respond to drug poisonings in Toronto's communities. On June 14, 2021, the Board of Health once again recognized the drug poisoning crisis as a public health crisis and reaffirmed commitment to supporting actions that are urgently needed to respond to the crisis and stem the tide of overdose deaths. These actions include calls for the immediate scale-up of safer supply initiatives, supervised consumption services and other harm reduction initiatives, as well as more affordable and supportive homes for people in need, including people who use drugs.

At the same meeting, the Board of Health requested the Medical Officer of Health to convene a multi-sectoral working group to develop a health- and social equity-based alternative approach to criminal penalties for the possession of all drugs for personal use in Toronto, as a step towards requesting an exemption under the Controlled Drugs and Substances Act, 1996.

The Controlled Drugs and Substances Act is administered by Health Canada and establishes the legislative framework that regulates the possession, distribution, and sale of unregulated drugs in Canada. Under Section 56(1) of the Act, the Federal Minister of Health has the authority to exempt jurisdictions, including municipalities and provinces, from provisions of the Act that criminalize drugs if the Minister deems it necessary for a medical purpose or it is in the public interest. The same authority has been used to allow supervised consumption services to operate in jurisdictions across Canada.

There are now growing calls for decriminalization across Canada, with support from civil society organizations, institutions, and law enforcement. On November 1, 2021, the Government of British Columbia became the first province in Canada to seek an exemption from Health Canada under Section 56(1). This follows a similar request from the City of Vancouver, and the endorsement of decriminalization by municipalities, such as Kingston, Montreal, and Ottawa, and organizations, such as Ontario's Big City Mayors and the Centre for Addiction and Mental Health. Further, both the Ontario Association of Chiefs of Police and the Canadian Association of Chiefs of Police have called for decriminalization.

Consistent with other jurisdictions, Toronto Public Health has initiated a consultation process as a step towards requesting an exemption under the Controlled Drugs and Substances Act from Health Canada for the possession of all drugs for personal use within Toronto's geographic boundaries (also referred to as the decriminalization of personal possession of drugs). This report provides an update on the process currently underway to develop an alternative approach to the criminalization of drugs in Toronto, including public and stakeholder consultation to inform an alternative model. There is widespread support for an alternative model that is grounded in a human rights and a public health approach in order to decrease stigma and harm for people who use drugs, while also improving the well-being of the communities around them.

It is important to note that decriminalization alone will not solve the drug poisoning crisis. Seeking an exemption from criminal penalties for personal possession is only one part of a comprehensive approach. To be successful in reducing the harms associated with substance use and criminalization of people who use drugs, the removal of criminal penalties must be accompanied by new investments from the provincial and federal governments and improved access to safer supply programs, harm reduction, and treatment initiatives. While some people use drugs without experiencing health-related harms or developing a substance use disorder, significant investments are needed from all levels of government to ensure low barrier access to health and social services for those most at-risk of drug-related harms.

On October 25, 2021, the Toronto Board of Health recommended that the Medical Officer of Health advocate to Health Canada and the Ontario Ministry of Health for funding for six key areas to address the drug poisoning crisis and to report back in December 2021 on the progress of funding negotiations as well as which areas should be funded immediately by the City of Toronto while funding from other governments is being sought.

This report requests funding for the Toronto Drug Strategy Secretariat, including 10 positions to address the increasingly complex issue of substance use, for the City's consideration through the 2022 Budget process. The expanded team will support population-level research and data and coordinate with intergovernmental and community partners to reduce drug-related harm and increase community health outcomes through the social determinants of health. This report also requests City funding, for consideration through the 2022 Budget process, for the implementation of an overdose alert app in shelters and respite centres as well as other public spaces to help reduce fatal overdoses for those using drugs alone.

This report also recommends that the Board of Health continue to request the remaining funding from the federal and provincial governments for new and enhanced programming as outlined in Item HL31.4, Toronto Public Health 2022 Operating Budget Submission. In addition, this report reiterates recommendations from the June 2021 Overdose Action Plan Update urging the provincial and federal governments to immediately scale-up critical life-saving programs including evidence-informed treatment, supervised consumption services, as well as develop a national framework to permit the simple possession of all drugs for personal use.

The Board of Health:

1.  Referred the Item to the Medical Officer of Health, with a request that they consult with relevant City of Toronto divisions and agencies, people with lived experience of substance use and residents and prepare an action plan to tackle the drug poisoning crisis across the City of Toronto and in the Eglinton Avenue West area; such action plan to consider the following as urgent priorities:

a.  a comprehensive and coordinated public health strategy that includes action from all three levels of government in order to provide enhanced prevention, harm reduction and medical support and interventions to address the drug poisoning crisis;

b.  providing data to support advocacy to the Ontario Ministry of Health and Ontario Health for the deployment of a Community Safety Team, based on the model currently being used at the temporary hotel shelters, in the Eglinton Avenue West area and other areas where the drug poisoning crisis appears to be impacting individuals and the local community;

c.  providing data to support advocacy to the Ontario Ministry of Health and Ontario Health for the establishment of additional treatment services in the City of Toronto, such as a permanent, storefront health clinic in the Eglinton Avenue West area, to provide urgently needed medical intervention and supports to people with substance use disorders; and

d.  expanded outreach to the Federal and Provincial Governments to secure additional resources for programs in support of the City of Toronto's efforts to address the drug poisoning crisis.

The Board of Health considered Items HL32.3 and HL32.4 together.

The Medical Officer of Health gave a presentation on Actions to Respond to the Drug Poisoning Crisis in Toronto.

City Council on November 9, 10 and 12, 2021, referred Motion MM37.4 to the Board of Health.

Summary from Motion MM37.4 by Councillor Mike Colle, seconded by Councillor Josh Matlow:

There is a growing opioid/fentanyl substance abuse crisis in communities within the Eglinton Avenue West area. This crisis is having devastating impacts on victims of opioid/fentanyl abuse and a coordinated, comprehensive, multi-partner public health response is required to help victims of substance abuse, and address the impact that this crisis is also having on the local residential and retail areas along Eglinton Avenue West.

There is a real and immediate need for medical intervention and support to help victims of opioid abuse.

Efforts to address this crisis have been ongoing by Toronto Public Health, community organizations, local residents, along with the local police at 13 Division, but these efforts need to be reinforced by additional agencies and resources in a comprehensive and coordinated way.

The Board of Health:

1.  Received the report (November 22, 2021) from the Medical Officer of Health for information.

The Minister of Health publishes the Ontario Public Health Standards: Requirements for Programs, Services and Accountability (OPHS) as per Section 7 of the Health Protection and Promotion Act. The Standards identify the minimum expectations for public health programs and services to be delivered by Ontario's 34 boards of health. Boards of health are accountable for implementing the Standards, including the requirement to have a self-evaluation process of its governance practices and outcomes.

This report contains the results of the self-evaluation of Toronto's Board of Health (BOH), conducted in October and November 2021. Overall, the BOH self-evaluation survey results were positive, including:

- Verifying that there is strong governance on the BOH and that members understand their roles and responsibilities;

- Highlighting effective relationships and informed decision-making, including in the current virtual meeting environment; and

- Identifying that the BOH is responsive to the immediate and long-term public health needs of the community.

 
In addition to the positive results, some opportunities and next steps were identified, including:

- Strengthening representation and participation in the BOH by members of communities most impacted by health inequities;

- Taking steps to improve board members' comfort in raising issues;

- Exploring and clarifying measures of success; and

- Increasing public participation in virtual Board of Health meetings.
 

At present, Toronto Public Health (TPH) remains focused on responding to the COVID-19 pandemic, with the majority of staff redeployed for this purpose. As capacity and resourcing permit, TPH will work with the City Clerk's Office and the Chair of the BOH to explore opportunities to address feedback provided through the 2021 BOH self-evaluation over the course of the current and upcoming terms of the BOH.

The Board of Health:

1.  Received the report (November 19, 2021) from the Medical Officer of Health for information.

This report provides an update to the Board of Health on the Toronto Public Health (TPH) Operating Budget Variance for the nine months ended on September 30, 2021.

As of September 30, 2021, TPH gross expenditure was overspent by $38.8 million gross and revenue was overachieved by $35.3 million, resulting in a net unfavourable variance of $3.5 million.

At year end, gross expenditure is expected to be overspent by $60.3 million gross and revenue will be overachieved by $60.3 million, resulting in net expenditure being in line with net budget.

The Board of Health:

1.  Received the report (November 19, 2021) from the Medical Officer of Health for information.

This report provides an update to the Board of Health on the Toronto Public Health Capital Budget Variance for the nine months ended on September 30, 2021.

As of September 30, 2021, Toronto Public Health spent $1,009.3 thousand representing 20.1 per cent of the 2021 Approved Capital Budget of $5,032.0 thousand. 

Similar to last year, projects planned for 2021 continue to be affected by the impact of COVID-19 on the availability of resources within Toronto Public Health and its partners.

The Board of Health:

1.  Approved the following 2022 meeting dates:

- Monday January 17 at 9:30 a.m.

- Monday March 21 at 9:30 a.m.

- Monday April 11 at 9:30 a.m.

- Monday May 16 at 9:30 a.m.

- Monday June 20 at 9:30 a.m.

In accordance with Section 25 of the Board of Health Procedures By-law, regular meetings of the Board are determined by the Board and a schedule of those meetings shall be publicly available by the first meeting of the Board in each calendar year.

On November 9, 10 and 12, 2021, City Council considered Item ST9.2, 2022 Schedule of Meetings, and approved the 2022 schedule of meetings for City Council and its Committees. The schedule also included proposed 2022 meeting dates for the Board of Health. The updated meeting schedule can be viewed on the City of Toronto's website at www.toronto.ca/council.

The Board of Health:

1.  Received the presentation (December 6, 2021) from Dr. Adam Kassam, President, Ontario Medical Association, headed "Prescription for Ontario: Doctors' 5-Point Plan for Better Health Care", for information.

Dr. Adam Kassam, President, Ontario Medical Association gave a presentation on Prescription for Ontario: Doctors' 5-Point Plan for Better Health Care.

Dr. Adam Kassam, President, Ontario Medical Association, will provide a presentation at the December 6, 2021 meeting of the Board of Health regarding Prescription for Ontario: Doctors' 5-Point Plan for Better Health Care.

The Board of Health:

1.  Requested the Medical Officer of Health to review the potential to declare a public health emergency as it relates to the phasing out of natural gas if the Province of Ontario refuses to implement such a policy in the coming year.

With Toronto set to debate its path to a 2040 Net Zero Climate Action Plan, it is imperative we look to ensure all of the City's efforts are geared toward achieving the targets our plan will set out.

The targets included in the City's plan are great, but the City of Toronto lacks the explicit powers to do what is necessary - a full phase out of natural gas in existing and new buildings imminently.

There are pathways the City can look to implement from other jurisdictions in Canada, but Toronto lacks the power to implement a phase out of natural gas equipment compared to Vancouver and other municipalities with greater powers granted to them by the province. As a result, the recommendations going to Council are requesting a phasing down of natural gas, but we are not able to institute it ourselves.

Toronto Public Health must play a role in protecting the public from the greatest health threat of this century. Climate change will exacerbate heart-related illness, lung and heart disease from wildfire smoke, vector-borne diseases including Lyme disease, and physical and mental illness from extreme weather events like flooding.

Therefore we should look to see if the Medical Officer of Health can support the City of Toronto to advance the issue. We have been able to demonstrate this power when we instituted a cosmetic pesticides ban which was later upheld and implemented province wide. If we can use the same mechanism again we can help influence the outcomes on this important file.

Announcements

The Chair recognized Director Peter Wong who 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.

The Chair recognized Director Mike Layton who read out the names of the 14 women who were murdered on December 6, 1989 at École Polytechnique de Montréal in Montréal, Québec. Director Layton noted that gender-based violence should be treated as a public health issue. The Board observed a moment of silence in honour of the 14 women.

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.