Decisions

The Board of Health recommends that:

1.  City Council request the provincial Ministry of Health to create an efficient system of transferring information from laboratories to public health units, including any necessary policy changes to information systems and changes to the Laboratory and Specimen Collection Centre Licensing Act or orders under the Emergency Management and Civil Protection Act.

2.  City Council request the provincial Ministry of Health to urgently develop a provincial COVID-19 Testing Strategy based upon clear objectives and the best available scientific evidence.

3.  City Council request the provincial Ministry of Health to adopt recovery indicators developed by the Medical Officers of Health in Ontario to inform provincial and local recovery decision-making.

4.  City Council request the City Manager to work with the Medical Officer of Health to develop enhanced approaches to providing coordinated support to Toronto Public Health, such as a predefined team which includes human resources, legal services, information technology, procurement, and other support functions, based on the experience to date, for use in response to future COVID-19 activity and other health emergencies.

5.  City Council request the City Manager to work with the John Howard Society of Toronto to re-establish critical assessment and support services for people leaving custody from the Toronto South Detention Centre, in accordance with public health advice on physical distancing requirements, at a location that is easily accessible to clients.

The Board of Health:

1.  Requested the provincial Ministry of Health to create an efficient system of transferring information from laboratories to public health units, including any necessary policy changes to information systems and changes to the Laboratory and Specimen Collection Centre Licensing Act or orders under the Emergency Management and Civil Protection Act.

2.  Requested the provincial Ministry of Health to urgently develop a provincial COVID-19 Testing Strategy based upon clear objectives and the best available scientific evidence.

3.  Requested the provincial Ministry of Health to adopt recovery indicators developed by the Medical Officers of Health in Ontario to inform provincial and local recovery decision-making.

4.  Requested the provincial Ministry of Education to consult and coordinate with local public health units on COVID-19 health-related communications to school boards in order to ensure that school boards and local public health units work together effectively in support of the health of local communities.

5.  Requested the Medical Officer of Health to report and make a presentation to the Board of Health at its July 2020 meeting on the status of COVID-19 recovery planning and a potential second wave outbreak in 2020 and beyond, including:

a.  the latest steps taken on the COVID-19 response to date;

b.  case and contact management improvements and the status of provincially-coordinated information systems;

c.  continued analysis of COVID-19 socio-demographic data and the latest findings regarding who is most at risk, including studying housing status and quality, occupation or employment sector, race and ethnicity, and other known social determinants of health;

d.  recommendations on the findings of the analysis of COVID-19 socio-demographic data to enhance protections for the public and those at highest risk; and

e.  consideration of accommodation options for people who cannot isolate in their own homes due to, for example, inadequate living space or family members at high risk for COVID-19.

6.  Requested the Medical Officer of Health to produce and regularly update a dashboard of COVID-19 Toronto Public Health recovery indicators and to make this information publicly available on Toronto Public Health's website.

The Medical Officer of Health gave a presentation on An Update on COVID-19.

Since January 2020, Toronto Public Health has been responding to the COVID-19 outbreak in the City of Toronto. Additionally, the Toronto Office of Recovery and Rebuild, which reports to the City Manager, was established on April 24, 2020. This Office is responsible for leading efforts to bring the City's own services back to a fully functioning state as well as to work with the Provincial Government, other public bodies and the private sector to promote a safe and orderly recovery from the impacts thus far of COVID-19 while rebuilding Toronto's economy and quality of life. These efforts will move forward only after the consideration of public health advice.

Lastly, the Public Health Recovery Team spans the Toronto Office of Recovery and Rebuild and Toronto Public Health. It is currently advising Toronto Public Health on the case and contact management function and continues to provide guidance on the re-opening of City services and businesses.

The Board of Health:

1.  Urged the federal Minister of Health to:

a.  grant an exemption under the Controlled Drugs and Substances Act to permit the

possession of all drugs for personal use for all Canadians, at least for the duration of the

COVID-19 pandemic, and to immediately scale up prevention, harm reduction, and treatment services;

b.  approve funding for Toronto Public Health's proposed injectable opioid agonist therapy (iOAT) at The Works to support the addition of this treatment option to the spectrum of safer supply initiatives available in Toronto; and

c.  support evidence-based knowledge exchange and capacity-building responses that reduce the harms of benzodiazepines and opioids.

2.  Reiterated its request urging the federal Minister of Health to increase funding for a spectrum of safer supply initiatives, including enhanced and flexible injectable and oral hydromorphone programs.

3.  Urged the provincial Minister of Health to:

a.  convene a multi-sectoral opioid overdose task force comprised of public health officials, community-based service providers, people with lived and living experience of drug use, and family members;

b.  expand the criteria for naloxone distribution to allow any organization that has clients who use drugs to distribute naloxone;

c.  provide funding to pilot and evaluate virtual and/or telephone-based supervised consumption services to complement the current in-person service options;

d.  remove the current cap of 21 Consumption and Treatment Services permitted for Ontario and utilize the federal class exemption granted to provinces during the COVID-19 pandemic to increase the availability of these lifesaving services in a variety of settings;

e.  provide funding to treatment and harm reduction services to enable them to adapt their services to adhere to COVID-19 public health requirements;

f.  support the increased use of virtual care for substance use treatment services for the duration of the COVID-19 pandemic;

g.  dedicate funding for grief and trauma supports specifically for overdoses; and

h.  consult with harm reduction services, health care providers, first responders, treatment providers, police, and people with lived and living experience of drug use to develop responses to benzodiazepine and opioid-related issues.

4.  Reiterated its request urging the provincial Minister of Health to support the implementation of managed opioid/safer supply programs, including by adding the required formulation of hydromorphone (i.e., 50 milligrams/milliliters and 100 milligrams/milliliters hydromorphone) to the Ontario Drug Benefit Formulary to enable injectable hydromorphone programs to operate.

5.  Urged the Office of the Chief Coroner for Ontario to report on the role of COVID-19 as a possible contributing factor in opioid toxicity deaths.

6.  Urged the Toronto Central Local Health Integration Network to increase funding for comprehensive crisis services for people who use drugs in Toronto.

7.  Requested the Medical Officer of Health, in consultation with the Director, Office of Emergency Management, City of Toronto, to ensure that Overdose Prevention Sites and Community Health Centres in Toronto, which are not currently receiving support from the Province of Ontario, are provided with Personal Protective Equipment through the local Community Cluster Coordinator or other appropriate means.

The Manager, Toronto Drug Strategy Secretariat, gave a presentation on Toronto Overdose Action Plan: Status Report 2020.

The ongoing opioid poisoning crisis in Toronto and across Canada has intensified and been further compounded by the COVID-19 global pandemic. These dual public health crises are having significant impacts on people who use drugs in our community as well as their families, friends and loved ones. Services that people rely on, many of them lifesaving, have closed or significantly reduced their service hours and/or capacity. During the first four months of 2020, paramedics responded to 1,307 suspected opioid overdose calls, including 71 calls involving deaths. In April 2020, paramedics responded to the highest number of suspected opioid overdose deaths (25) since September 2017.

This staff report highlights actions taken to implement the Toronto Overdose Action Plan since the last status report in June 2019 and includes issues related to the COVID-19 pandemic. The report also recommends additional urgent actions that are needed to address the opioid poisoning crisis, especially in the context of the pandemic and the increasingly toxic unregulated drug supply. The need for a fundamental change toward a public health approach remains critical to improving the health outcomes of people who use drugs.

Toronto Public Health remains committed to working with our community and institutional partners to improve our collective overdose prevention and response efforts, and to improving the health and well-being of people who use drugs, which is even more of an imperative during this time of dual public health crises.

The Board of Health:

1.  Directed the Medical Officer of Health to allocate $3,421,368 for 13 one-year projects from 2020-2021 totalling $635,508 and 39 three-year projects from 2020-2023 totalling $2,785,860, as recommended by Toronto Public Health staff and outlined in Appendices 2 and 3 to the report (May 29, 2020) from the Medical Officer of Health.

2.  Directed the Medical Officer of Health to execute Funding Agreements with the approved applicants.

This report outlines the Toronto Urban Health Fund's funding priorities, review process, and funding recommendations for Board of Health approval. Toronto Public Health staff recommend the total allocation of $3,421,368 for 13 one-year projects totalling $635,508 and 39 three-year projects totalling $2,785,860 to be used between July 1, 2020 and June 30, 2021. Recommended projects focus on HIV prevention through sexual transmission, harm reduction, child and youth resiliency and Indigenous health promotion.

The Board of Health recommends that:

1.  City Council authorize the Medical Officer of Health to enter into agreements totalling $16,029,626 with the Angel Foundation for Learning ($4,352,722) and the Toronto Foundation for Student Success ($11,676,904) to administer the 2020 approved municipal funding to eligible student nutrition programs across the City of Toronto.

2.  City Council authorize the Medical Officer of Health to take the necessary actions to give effect to Recommendation 1 above, including the execution of legal agreements with the Angel Foundation for Learning and the Toronto Foundation for Student Success, on behalf of the City of Toronto.

3.  City Council request the Provincial Government to increase its grant funding investment proportionally to match the increased City of Toronto investment.

4.  City Council request the Federal Government to provide core funding for a national school food program.

The Board of Health:

1.  Requested the Provincial Government to increase its grant funding investment proportionally to match the increased City of Toronto investment.

2.  Requested the Federal Government to provide core funding for a national school food program.

3.  Directed that the report (May 29, 2020) from the Medical Officer of Health be forwarded to the provincial Minister of Children, Community and Social Services, the provincial Minister of Health, the provincial Minister of Education, the Toronto District School Board, the Toronto Catholic District School Board, le Conseil scolaire Viamonde, le Conseil scolaire catholique MonAvenir, the Angel Foundation for Learning, the Toronto Foundation for Student Success, and FoodShare Toronto.

This report outlines recommendations for the 2020 Student Nutrition Program service subsidy allocations. The proposed combined allocations to the Angel Foundation for Learning (AFL) and the Toronto Foundation for Student Success (TFSS) total $16,029,626 which includes $266,000 held in reserve for appeals/late applications.

The Board of Health:

1.  Received the report (May 29, 2020) from the Medical Officer of Health for information.

This report provides an update to the Board of Health (BOH) on Toronto Public Health's (TPH) 2020 Operating Budget which was approved at the February 19, 2020 City Council meeting.

In September 2019, the BOH recommended a 2020 Operating Budget of $269,684.5 thousand gross and $69,876.3 thousand net that included nine reduction options and two proposals for new and enhanced services. Decisions made during the subsequent 2020 City budget process are outlined in this report.

City Council approved TPH's 2020 recommended Operating Budget of $269,153.8 thousand gross and $69,408.8 thousand net. The City Council Approved Budget provides an increase of $12,424.5 thousand gross (4.8 percent increase in gross expenditures) and $5,532.1 thousand net (8.7 percent increase in net expenditures) more than the 2019 Approved Operating Budget.

The Board of Health:

1.  Received the report (May 29, 2020) from the Medical Officer of Health for information.

This report provides an update to the Board of Health (BOH) on Toronto Public Health's (TPH) 2020 Capital Budget and 2021-2029 Capital Plan as approved by City Council on February 19, 2020.

The Board of Health:

1.  Received the report (May 29, 2020) 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 twelve months ended on December 31, 2019.

As of December 31, 2019, TPH's 2019 Operating Budget had a favourable variance of $552.3 thousand net (0.8 percent).

The Board of Health:

1.  Received the report (May 29, 2020) from the Medical Officer of Health for information.

This report provides an update to the Board of Health on the Toronto Public Health (TPH) Capital Budget Variance for the twelve months ended on December 31, 2019.

As of December 31, 2019, TPH spent $3.852 million, representing 79.2 percent of the 2019 Approved Capital Budget of $4.865 million.

The Board of Health:

1.  Recognized anti-Black racism as a public health crisis.

2.  Affirmed its commitment to continuing to address the social determinants of health by supporting policies and programs that address the inequities that marginalized groups continue to face, with a focus on Black communities and residents, including in the following areas: employment, education, housing, child care, policing and law enforcement, the criminal justice system, and access to health and mental health services.

3.  Requested the Medical Officer of Health, through the 2021 Budget process and COVID-19 recovery planning, to make recommendations to the Board of Health on reprioritizing the City of Toronto's resources to address the social determinants of health, including specifically a focus on anti-Black racism.

4.  Requested the Medical Officer of Health, in accordance with public health advice on physical distancing requirements and the Provincial Order that limits public gatherings, to reschedule a three-hour training session for the Board on Anti-Black Racism, Understanding Equity from Africentric Values and Principles, and Embedding Equity and Anti-Black Racism in Governance and Leadership from the TAIBU Community Health Centre and its partners, that was cancelled due to the COVID-19 pandemic, in order to build the Board's capacity to provide equitable space for racialized and marginalized representation.

5.  Requested the Chair to write to the Chair, Civic Appointments Committee, City of Toronto, to convey the Board's desire that its membership reflect the full diversity and range of voices in our city, with particular attention to voices from Black communities, during the next recruitment of Board of Health members and in the event of any vacancies.

Toronto is the most diverse city in the world. At the same time, anti-Black racism is a historic, pervasive, and systemic issue in our city.

Racism has numerous consequences: Black Toronto residents are more than twice as likely to be living in low-income households than residents who are not a visible minority, and 44 percent of Black children live in poverty, compared to 15 percent of non-racialized children. Black women in Ontario earn 57 cents for every dollar that a non-racialized man earns. Black people in our city experience racial profiling and anti-Black discrimination within our institutions, along with higher rates of precarious employment and unemployment, significant poverty, and overrepresentation in the criminal justice, mental health, and child welfare systems.

The intersection of race, income, housing, and other social determinants of health have placed Black Torontonians at great risk, as we are seeing through the disproportionate impact of COVID-19 on communities with higher percentages of visible minorities. This is tragic, it is unacceptable, and it needs to change.

In order to adequately address anti-Black racism in our city, we must approach it from a public health perspective.