TABLE OF CONTENTS

REPORTS OF THE STANDING COMMITTEES

AND OTHER COMMITTEES

As Considered by

The Council of the City of Toronto

on July 29, 30 and 31, 1998

BOARD OF HEALTH

REPORT No. 10

1No Fixed Address: Young Parents on the Street

2Air Quality and a Federal Standard for Sulphur in Fuel

3Council Representation on the Board of Health

4Energy Efficiency in Buildings and Active Transportation

5Queen Elizabeth II Sesquicentennial Scholarship Award in Public Health Nursing

City of Toronto

REPORT No. 10

OF THE BOARD OF HEALTH

(from its meeting on July 27, 1998,

submitted by Councillor John Filion, Chair)

As Considered by

The Council of the City of Toronto

on July 29, 30 and 31, 1998

1

No Fixed Address: Young Parents on the Street

(City Council on July 29, 30 and 31, 1998, adopted this Clause, without amendment.)

The Board of Health:

(1)requested that this matter be considered by Council at the same time it considers Clause No. 2 of Report No. 7 of The Community and Neighbourhood Services Committee, entitled "Diversion Options for Youth Involved in the Squeegee Trade";

(2)recommends the adoption of Recommendation (2) of the report (July 10, 1998) from the Medical Officer of Health;

(3)recommends that Council endorse the remaining recommendations contained in the foregoing report from the Medical Officer of Health;

(4)urges Council not to use punitive measures to deal with street youth, and youth involved in the squeegee trade; and

(5)recommends that lands and/or properties be reserved which may be suitable to assist in meeting the housing needs of the young parents, and other youth identified in the foregoing report.

The Board of Health reports, for the information of Council, having:

(1)adopted the recommendations contained in the report (July 10, 1998) from the Medical Officer of Health;

(2)referred the foregoing report from the Medical Officer of Health to:

(a)the Advisory Committee on Homelessness, the Council Strategy Committee for People without Homes, and the Community and Neighbourhood Services Committee for information;

(b)the Social Infrastructure Committee of the Federation of Canadian Municipalities with a request that similar information as that contained in this report be gathered and exchanged, and that the Federation of Canadian Municipalities assist in the coordination of developing any new national programs that may respond to these programs;

(3)requested the Medical Officer of Health to work with community partners in developing a public education campaign in support of homeless youth; and

(4)expressed its support of the following Recommendation (3) of the report (July 6, 1998) from the Commissioner of Community and Neighbourhood Services contained in Clause No. 5 of Report No. 7 of The Community and Neighbourhood Services Committee entitled "Change in Funding Responsibility for Supportive Social Housing":

"(2)the Commissioner of Community and Neighbourhood Services and the Chief Financial Officer report back on reallocation of $11.7 million which was set aside in the 1998 City Operating Budget for Social Housing Costs, and is no longer required due to the Province's decision to retain funding for 100 percent supportive housing portfolios. Potential uses for this fund would include providing support for affordable housing demonstration projects."

The Board of Health submits the following report (July 10, 1998) from the Medical Officer of Health:

Purpose:

Recent increases in the numbers of pregnant and parenting teens without stable housing is of urgent concern. The working committee Young Parents, No Fixed Address (NFA) was convened in December, 1997 by Toronto Public Health at the request of workers at local agencies (see Appendix1), to help coordinate existing services for the growing numbers of young parents and children without homes. The committee's concerns for the health and welfare of these young families are discussed in this paper, along with recommendations for addressing the situation, based upon available data and information collected by the group.

Source of Funding:

Not applicable.

Recommendations:

It is recommended that:

(1)the Board of Health support the working committee on Young Parents, No Fixed Address to ensure ongoing co-ordination amongst youth serving agencies, and the continued development of flexible, alternative approaches that address the urgent needs of this population;

(2)the Board of Health urge City Council to ensure an increased supply of safe, affordable transitional and permanent housing stock and to eliminate barriers to access housing in both the public and private sector for this population;

(3)the Board of Health urge the provincial and federal Minsters of Housing to develop an increased supply of safe, affordable, transitional and permanent housing stock and to eliminate barriers to access housing in both the public and private sector for this population;

(4)the Board of Health direct Toronto Public Health to continue as a partner in the group, participating in programs that will include: a) food access and supplementation; b) development of a youth advisory board; c) further development of parent relief programs; d) development of responses to mental and emotional health problems; and e) continued data collection and monitoring;

(5)the Board of Health continue to support existing programs and services essential to street youth such as provision of classes outside schools in the community and advocate to the Minister of Education, the Toronto District School Board and the Catholic School Board to ensure these programs;

(6)the Board of Health advocate to the Minister of Community and Social Services for adequate provincial funding for child welfare and protection in order to ensure that caseloads are manageable and realistic for the protection of children and the prevention of abuse and neglect;

(7)the Board of Health advocate to the Minister of Health and to the Minister of Community and Social Services for the development of pro-active, early intervention strategies to prevent the rise in numbers of street youth and children;

(8)the Board of Health forward this report to the Assistant Deputy Minister - Integrated Children's Services, the Toronto District School Board, the Catholic School Board, the Children's Action Committee, and the Toronto Child Advocate;

(9)the Board of Health refer this report to Community and Neighbourhood Services for information and to City Council for adoption; and

(10)the Board of Health forward this report to the Premier of Ontario to urge him to ensure that the growing needs of young parents on the street be addressed through coordinated action of the part of the relevant Ministries.

Background:

Why are there youth without homes in Toronto?

The reasons young people trade their homes for the streets are confirmed in a number of studies.^13,14,15,21 A 1992 study of street youth in Toronto described "a population of adolescents in special circumstances, more than 70 percent of whom leave home because of physical and/or sexual abuse."¹⁴ Confirmation of the high prevalence of chaotic childhood experiences and serious emotional problems among these youth are found in several local data sources (see Tables 1A, 2A, Appendix2).

Estimates of the number of homeless youth in Toronto are extremely wide-ranging^13,15,21,29 and the source of considerable debate. The statistics available indicate that between 5,000 and 20,000 teens spend time on the streets each year. Studies which attempt to enumerate homeless populations are exceptionally difficult to complete due to the transient lifestyles of this group. ²⁵ A 'census' of homeless persons has not been undertaken in Toronto.

Youth Hostel utilization figures provide one "official" indicator of the size of the street youth population in Toronto. According to statistics from Hostel Division, Community and Neighbourhood Services, approximately 325-340 youth between the ages of 16-24 use hostels nightly in Toronto³¹. In addition, there are youth who avoid these services and make alternative arrangements. Discussions with front-line professionals indicate that the number of youth in this latter group may equal the number of youth registered in hostels. Overall, Hostel Division statistics record over 5,000 youth using their facilities annually (see Table 3, Appendix 2).

There is strong evidence that the total number of street youth in Toronto has increased over the past several years. Utilization data from the Second Base Youth Shelter, one of nine hostels for youth between the ages 16 and 24, indicate a steady increase in the number of youth seeking shelter, from just over 500 in 1994 to nearly 900 in 1996 (see Table 4, Appendix 2). This 70 percent increase is particularly noteworthy, as it has been recorded in a facility located outside of Toronto's downtown core. Along with the increasing number of homeless youth, the growing number of homeless families sheltered outside of the inner city is significant, given the relatively few resources available in these areas. Of particular concern is the lack of accessible medical care for homeless individuals outside of the city's central core.

The number of children of homeless young parents, growing up without permanent homes, is another concern. Records from local maternity homes and shelters in downtown Toronto are the only data available regarding numbers of births among homeless women (see Tables 5A-6C, Appendix 2). The most recent figures, from the mid-1990's, document more than 200 births annually to residents in these facilities, with approximately 30 percent to teens.^1,2,3,4. The addition of women living in other circumstances at the time of delivery would likely bring this total to over 300 annually. More recent information regarding increases in pregnancies among homeless teens suggest this figure may still underestimate the number of children born to young mothers on the streets^5,6,7 (see Tables 7-9, Appendix 2).

Discussion:

Health Issues

The erratic nature of street life poses obvious threats to the health of this growing homeless population. Of all the risks they face, one of the most prominent fears among street youth is that of assault. Crime and violence ranked second among the ten most important problems cited by Toronto street youth in a 1990 survey, exceeded only by homelessness. The great majority have been physically and/or sexually assaulted at least once.¹³ Some youth report that sleeping during the day and walking all night allows them greater peace of mind.

The danger of sexual assault is heightened by common practices of "survival sex" and prostitution. Street youth are constantly in need of money and find that exchanging sex for housing, and other favours, are among their limited options.^23,26,28 Several young women involved in prostitution have been murdered over the past several years in Toronto, although the precise figures are not readily available.

A recent study of homeless young women in Toronto indicates that more than half become pregnant. Multiple pregnancies are also common, with 118 pregnancies among the 93 women interviewed. Lack of adequate prenatal care adds to the inflated risks for homeless young women and babies and results in extremely high rates of premature delivery. It is estimated that more than 10 percent of these babies do not survive.²⁸

Substance abuse on the street is another serious concern. In an extensive study of Toronto street

youth in 1992, more than 25 percent reported problems with one or more drugs. Rates of alcohol use were exceptionally high, with an average reported weekly consumption of 15 drinks. Over one quarter of those interviewed had injected drugs at some point in their lifetime; four percent had shared needles with others.¹⁴ The rate of HIV among street youth was reported as seven-times that expected in this age group.²¹

In addition, further serious health risks are related to inadequate nutrition, lack of rest, and limited opportunities for good hygiene and prevention practices^29,30,37. These factors further complicate high risk pregnancies while increasing susceptibility to serious acute and chronic infections. Not surprisingly, these significant physical risks, coupled with an often traumatic past, result in high levels of mental health problems as well. Estimates of clinical depression among street youth range between 35-50 percent¹⁴. The number who attempt suicide is also disturbing. Of the 217 street youth interviewed by the Addiction Research Foundation in 1992, 43 percent indicated at least one such attempt at some point in their lives. Females were significantly more likely to report such attempts (61percent vs 37 percent). Other studies confirm these alarming rates.^21,27,28

These critical health concerns naturally extend to the children of these youth. Numerous acute and chronic health risks are associated with lack of access to adequate nutrition and to a clean, safe, and secure living environment in childhood.^15,27 In addition, many of these children suffer developmental delays, a result of low birth weight, as well as lack of attention and stimulation. Added to these problems are increased risks of physical abuse and neglect, as well as high levels of parental substance abuse, stemming from the often overwhelming levels of stress experienced by their parents.^20,32

Given these serious physical and emotional risks, it is not surprising that about one-half of the babies born to homeless teens are no longer in their mother's custody by the time they are two years old. ³⁸ Loss of custody is generally a devastating failure to these young women, leading to further serious emotional problems for themselves and the children.³² This is often a cyclical process; many of these women become pregnant again to try and replace this loss, with further impact on their emotional state.

Addressing the Needs

The most urgent need of these young parents and their children is safe, affordable housing. Unfortunately, formidable obstacles stand in the way. Of primary concern is the inadequate income on which these families must exist. Appendix 3 displays a sample monthly budget for a teenage mother on welfare. Based on the $957.00 stipulated by social assistance, the maximum shelter allowance of $575.00 leaves only $382.00 to pay for food, transportation, and all other needs each month. Those who are forced to pay more than the rent allowance provides must take additional money from other items in the budget.

Compounding the problem is the very limited availability of affordable housing. Waiting lists for subsidized units in social housing have tripled since 1990.¹⁷ As of February, 1998 the combined waiting lists for MTHA, MTHCL, and Cityhome stood at approximately 41,000.¹⁸ A vacancy rate of well below 1 percent in the private market further limits availability.

The absence of a centralized system allowing applicants to access information on a range of housing units has been a further impediment. The system of advertising and filling vacancies is often informal. Homeless youth, generally without telephones or mailing addresses, have limited access to information regarding upcoming vacancies. The new Toronto Social Housing Connections system has been designed to simplify the process, with information on 800 buildings, as well as other social services. However, the supply of affordable units will not be increased by this project.

Additional complications exist for mothers under 18 years of age. Often considered too young to sign a lease by private landlords, some temporarily use rooming houses. These accommodations are often dirty and unsafe, and not appropriate for infants and children. Shelters and other shared accommodations are additional options, but are often overcrowded, and unsuitable for young children, intensifying the young mother's feelings of loneliness, vulnerability, and despair.¹⁹

Along with the urgent need for stable housing, homeless teen parents require strong, ongoing support with parenting. The conditions which bring youth to the streets generally imply a severing of ties with their own parents. While friends on the street may provide a surrogate family, they generally cannot provide support in terms of parenting responsibilities. As a result, these teens are generally caring for small children 24 hours a day, without a permanent residence, and with little money. Front line workers note that assistance with parenting is vital in preventing crises of desperation that do occur³³. 'Hot' lines for these emergency situations are another urgent need. In addition to crisis services, programs which offer information on parenting are vital in insuring the well-being of the children of street youth. Education for males, to help them assume their responsibilities as fathers, is crucial. Because their own childhood experiences generally leave these teens without positive role models in caring for their own children, programs which incorporate information on parenting with a wide range of other basic health services, including information on child health and nutrition, are vital to ensuring child protection.

The prevalence of serious addiction problems among street youth call attention to another critical need. The birth of a child is a life changing experience, which can provide the motivation for a new parent to overcome drug dependency and work toward a more stable lifestyle for themselves and their children. ^22,26,32 Numerous studies have identified the lack of treatment programs with provisions for day care as a major barrier in addressing are addiction problems in young mothers over the past several years.^32,33 Unfortunately, however, the gap remains. Reports of increasing numbers of babies born in Toronto with evidence of prenatal drug exposure further emphasize the need for maternal addiction treatment.³³ Long-term counselling and other supports, to prevent relapse in these vulnerable new parents, is an essential part of drug addiction treatment.

Conclusions:

Despite limited access to food, shelter, and health care for themselves and their children, youth on the street are often "service-shy". Early experiences with child welfare agencies can be traumatic, often resulting in a lack of trust in authority. Fear of losing their children to these same authorities creates perhaps the most difficult barrier to overcome in working with homeless teens, transcending all areas of need. This dilemma clearly illustrates the cyclical nature of the problems of child abuse, neglect, homelessness, and early pregnancy. Further stigmatization resulting from life on the streets can be an additional disincentive to receiving urgently needed food and shelter or attending to medical and dental emergencies. Local agencies, including Public Health, devote considerable efforts to "outreach", which involves identifying individuals in need of assistance and encouraging them to accept help. Discussions with outreach staff indicate that beyond the fear of these young women is often a tremendous desire to provide a better life for their children. A number of local programs have demonstrated how these many of these young women can draw upon the strengths they use to survive on their own to achieve this goal.^32,38

The network of agencies formed through Young Parents No Fixed Address has, in its first six months of existence, demonstrated the importance of inter-agency collaboration in working with resistant yet needy clients. Modifications to the system of identifying high risk parents and children, expanded case conferencing, use of designated teams and coordination of services and data collection have been initiated through this partnership. Such collaboration is seen as vital in helping to ensure that these youth and their children do not "fall between the cracks."

Significant increases in child welfare rolls over the past several years virtually guarantee a continued growth in the street youth population in Toronto (see Tables 10A - 11, Appendix 2). The promise of an expanding population of young families living without permanent homes underscores the urgent need for increased attention to this tragedy on Toronto's streets.

Contact Name:

Dr. Jack Lee, Regional Director

Toronto Public Health

Tel:(416) 392-7467

Fax:(416) 392-0713

E-mailjlee1@city.toronto.on.ca

Dr. Joyce Bernstein, Epidemiologist

Health Information & Research

Toronto Public Health

Tel:(416) 392-6788

Fax:(416) 392-7418

E-mail: jbernste@city.toronto.on.ca

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Dr. Jack Lee and Dr. Joyce Bernstein, Public Health Division, gave a presentation to the Board of Health in connection with the foregoing matter.

The following persons appeared before the Board of Health in connection with the foregoing matter:

-Councillor Olivia Chow, Downtown

-Councillor Jack Layton, Don River

(A copy of each of the following, referred to in the foregoing report, was forwarded to all Members of Council with the agenda of the Board of Health for its meeting on July 27, 1998, and a copy thereof is on file in the office of the City Clerk:

-Appendix 1 listing Agencies Participating in Young Parents No Fixed Address;

-Appendix 2 listing summarized statistics from Agencies Participating in Young Parents No Fixed Address;

-Appendix 3 listing Sample Budget for Single Mother with One Child; and

-Footnotes.)

2

Air Quality and a Federal Standard for Sulphur in Fuel

(City Council on July 29, 30 and 31, 1998, adopted this Clause, without amendment.)

The Board of Health recommends:

(1)that Council endorse the action taken by the Board of Health whereby the Board adopted the report ( July 13, 1998) from the Medical Officer of Health subject to:

(a)amending Recommendation 2 by adding thereto the following:

"and the Provincial Minister of the Environment";

(b)amending Recommendation 2(b) by deleting the words "particularly for off-road vehicles" and adding thereto the following:

"and that standards for off-road vehicles be brought into line with on-road vehicles";

(c)amending Recommendation 2(c) by adding the words "from federal and provincial fuel taxes" after the words "income replacement program";

so that such Recommendation now reads:

"(2)the Federal Minister of Environment and the Provincial Minister of the Environment:

(a)establish sulphur limits for gasoline at an annual average of 30 ppm and a maximum of 80 ppm across Canada, effective January 1, 2002, as outlined in option A.1 in the report of the Government Working Group;

(b)establish sulphur levels for diesel that maximise the health benefits for residents across Canada before the year 2000, and that standards for off-road vehicles be brought into line with on-road vehicles;

(c)establish an environmental income replacement program from federal and provincial fuel taxes, complete with re-education funds to assist workers dislocated by plant closures that may result from sulphur standards set for gasoline and diesel; and"

(2)that Council's action in this respect and the report (July 13, 1998) from the Medical Officer of Health be forwarded to:

(a)the Federation of Canadian Municipalities and the Association of Municipalities of Ontario for endorsement;

(b)to all Municipalities in Ontario with a population over 50,000 for endorsement together with a covering letter from Mayor Lastman outlining the extenuating circumstances of this matter;

(3)that a review of the City of Toronto's Fuel Purchase Program be undertaken and request the Medical Officer of Health to report to both the Board of Health and Corporate Services Committee on the possibility of requiring that all fuel provided to City of Toronto and City Agency vehicles meets the 30 ppm standards as recommended in her report dated July 13, 1998; and

(4)that Council be encouraged to accelerate its Green Fleet Program.

The Board of Health reports, for the information of Council, having:

(1)requested the City Solicitor to report back to the Board of Health on the feasibility of enacting a Municipal By-law to control sulphur levels in gasoline and diesel fuel in the City;

(2)requested the Medical Officer of Health to report to its next meeting on September 15, 1998 on the implementation of the provincial government's Drive Clean Program, in particular its Vehicle Emission Testing Program; and

(3).urged the Chief Executive Officers of all gasoline producers to act on the foregoing action taken by the Board of Health with respect to its adoption, as amended, of the recommendations contained in the report dated July 13, 1998 from the Medical Officer of Health.

The Board of Health submits the following report (July 13, 1998) from the Medical Officer of Health:

Purpose:

To provide comments to the Federal Minister of Environment and the Government Working Group on the sulphur standards proposed for gasoline and diesel.

Recommendations:

It is recommended that:

(1)the comments prepared and submitted to the Government Working Group by the Medical Officer of Health be received for information (see attached letter);

(2)the Federal Minister of Environment:

a)establish sulphur limits for gasoline at an annual average of 30 ppm and a maximum of 80 ppm across Canada, effective January 1, 2002, as outlined by option A.1 in the report of the Government Working Group;

b)establish sulphur levels for diesel, particularly for off-road vehicles, that maximize the health benefits for residents across Canada before the year 2000; and

c)establish an environmental income replacement program, complete with re-education funds, to assist workers dislocated by plant closures that may result from sulphur standards set for gasoline and diesel; and

(3)That City Council be asked to endorse this report and these recommendations.

Background:

In 1996, Environment Canada established a process to set limits for sulphur in gasoline and diesel in collaboration with other federal departments, provincial governments, industry and non-governmental organizations in response to recommendations from the Canadian Council of Ministers of the Environment (CCME). As part of this process, three expert panels were struck to prepare reports on issues related to the various proposed sulphur levels: the Atmospheric Science Expert Panel, the Health and Environmental Impact Assessment Panel, and the Cost and Competitiveness Assessment Panel. Nine sulphur scenarios were examined: six sulphur levels for gasoline; one sulphur level for off-road diesel; and two sulphur levels for on-road diesel (see Table 3). Reports prepared by these panels were released in the fall of 1997.

A Government Working Group, with representatives from five federal departments and six provincial ministries, has prepared a preliminary report, "Setting a Level for Sulphur in Gasoline and Diesel", which summarizes and analyses the expert reports and other background information, and presents a variety of options for government action. That report was released in May 1998 for public comment. The final report is scheduled to be completed this summer and is expected to be tabled by the Federal Minister of Environment at a CCME meeting in the fall of 1998.

Comments:

Trend in Sulphur Levels in Gasoline

Worldwide, the trend is towards lower levels of sulphur in gasoline. Currently, the average level of sulphur in gasoline is higher in Canada, at 340 parts per million (ppm), than in many other developed nations. Within Canada, the sulphur levels are highest in Ontario with an average of 540 ppm.

In the United States, sulphur levels in gasoline are affected by the U.S. regional reformulated gas program (RFG) started by the federal government in 1995. The RFG program applies to regional areas that do not comply with ambient air standards. Phase 2 of the program, commencing in 2000, will indirectly control sulphur levels in gasoline through nitrogen oxide emissions performance modelling. This is projected to result in an average sulphur level of between 130 and 180 ppm in RFG areas. The sulphur content of conventional gasoline outside the RFG areas has been frozen at 1990 levels since 1995 at an average level of 295 ppm.

In the State of California, sulphur levels in gasoline have been capped at an average of 30 ppm or a maximum of 40 ppm since 1996. In Japan, the government limits sulphur levels in gasoline at a maximum of 100 ppm. The European Union has agreed to apply a 150 ppm sulphur limit to gasoline in the year 2000, and its Council of Ministers have proposed a 50 ppm limit for the year 2005.

Sulphur Limits and Air Pollution

Sulphur affects the performance and operation of current and newly developed technologies used to control vehicle emissions. Consequently, when sulphur levels in gasoline are reduced, vehicle emissions of carbon monoxide, nitrogen dioxide and fine particulates are reduced as well as sulphur dioxide and sulphates. The Atmospheric Science Expert Panel has calculated the changes in ambient air quality for each of the nine sulphur scenarios. For gasoline scenarios, the 30 ppm sulphur level would produce the greatest reductions in ambient air levels of carbon monoxide, nitrogen oxides, sulphates and sulphur dioxide (see Table 1). For example, the Panel estimated that the 30 ppm sulphur level could reduce carbon monoxide levels in air by 10-68 ppm in the seven Canadian cities examined (ie. Halifax, Saint John, Montreal, Toronto, Winnipeg, Edmonton and Vancouver) by the year 2020. The greatest reductions in all of the pollutants examined for gasoline were predicted for the Toronto area because of the large number of vehicles and high sulphur levels.

Sulphur Limits and Human Health

The Health and Environmental Impact Assessment Panel used the Damage Function Approach applied by the United States Environmental Protection Agency, to compute the impacts and benefits associated with the nine different sulphur scenarios. The Damage Function Approach involves five steps: in the first step, the changes in air emissions are calculated for each scenario; in the second step, the air emissions are translated into changes in ambient air quality; in the third step, the human health impacts are calculated; in the fourth step, the human health effects are assigned an economic value; and in the fifth step, the benefits are computed for different health impacts, locations and time periods.

Using this approach, the Health and Environmental Impact Assessment Panel determined that the 30 ppm sulphur limit in gasoline could prevent 1,352 premature deaths, 1,537 hospital admissions, 3,760 emergency room visits, 517,000 asthma symptom days, 62,000 incidents of bronchitis in children, and 17.9 million acute respiratory symptoms in the seven Canadian cities over a twenty year period (see Table 2).

For the Toronto area, the Panel estimated that the 30 ppm sulphur limit could prevent 136 cases of chronic respiratory disease and 513,571 cases of acute respiratory symptoms in the year 2001. The monetary value of the health effects avoided in the Toronto area with a 30 ppm limit was estimated at $205 million in the year 2001. This compares with estimates of $165 million with a 150 ppm limit and $92 million with a 360 ppm limit.

When the monetary benefits of the avoided health outcomes were calculated for all seven Canadian cities over a twenty year period, it was estimated that the 30 ppm sulphur limit was worth $5.2 billion in health benefits with a 3 percent discount for inflation built in. This can be compared to health benefits worth $3.9 billion with a 150 ppm sulphur limit and $2.1 billion with a 360 ppm sulphur limit (see Table 3).

Benefit-Cost Analysis

While the compliance costs associated with the 30 ppm sulphur standard are substantial, the health benefits are much greater. The Cost and Competitiveness Assessment Panel estimated that it could cost the refining industry $1.8 billion in one-time capital costs and $119 million in annual operating costs to comply with a 30 ppm sulphur limit for gasoline. The Panel suggested that these compliance costs could threaten the viability of 3 or 4 of the 17 refineries operating in Canada, 1 or 2 of which operate in Ontario. The 30 ppm sulphur limits could result in gasoline price increases of $0.01 per litre.

However, when the compliance costs were compared against the monetary value of the avoided health outcomes, it was determined that the health benefits associated with the 30 ppm sulphur level would outweigh the compliance costs by a 2:1 ratio for Canada as a whole. In Ontario, where sulphur levels are the highest, a greater proportion of vehicles are gas powered, and the population is the greatest, it was determined that the health benefits would outweigh the compliance costs by a 4:1 ratio. The health benefits of the 30 ppm limit for Ontario when calculated for a twenty year period were estimated at $6.14 billion.

While the health benefits will be shared by Canadians across the country, albeit disproportionately by those living in areas with the poorest air quality, the compliance costs may be born inequitably by workers dislocated from refineries that could close as a result of the 30 ppm sulphur standard. To ameliorate the effects of this dislocation, the federal government should establish an environmental income replacement program, complete with re-education funds, to assist workers who may be affected.

Sulphur Levels and Vehicle Technology

The Association of International Automobile Manufacturers of Canada and the Canadian Vehicle Manufacturers' Association have indicated that vehicle manufacturers cannot continue to improve vehicle emissions or fuel efficiency without commensurate improvements in the quality of vehicle fuels. These Associations have indicated that sulphur reduces the efficiency and performance of vehicle emission control technologies, particularly those designed for low emission vehicles. They have also indicated that the new technologies designed to improve fuel efficiency are more susceptible to sulphur. This view has been expressed by staff in the United States Environmental Protection Agency (US EPA) as well. In a May 1998 report entitled,"Staff Paper on Gasoline in Sulphur Issues", the US EPA indicates that:

"While sulphur has a large impact on emissions from current low-emission vehicles, technological advances are also being made to improve the fuel efficiency of the nation's vehicles. Gasoline direct injection engines and fuel cells are two of the advanced power plants being developed. Both of these technologies may be more sensitive to sulphur than current vehicles."

Vehicle manufacturing associations in the United States have petitioned the US EPA to promulgate a regulation which caps sulphur levels in all gasoline at an average of 30 ppm and a maximum of 80 ppm as quickly as possible.

Options for Action on Sulphur in Gasoline

The Government Working Group has presented five options for action on sulphur levels in gasoline (see Table 4). The 30 ppm sulphur limit for gasoline has been supported by the Ontario Medical Association, International Joint Commission, and Pollution Probe. The International Automobile Manufacturers of Canada and the Canadian Environmental Law Association (CELA) have recommended that the 30 ppm sulphur standard should be implemented according to option A.1. The Cities of Welland, St. Catharines and Mississauga have passed resolutions calling for meaningful reductions in the sulphur content of gasoline. The Canadian Petroleum Products Institute (CPPI) has recommended a policy of "harmonization of Canadian sulphur levels with conventional gasoline in the United States". This proposal would allow Canadian sulphur levels in gasoline to follow those established for non-reformulated gasoline areas where the average is currently 295 ppm.

Given the compelling health and socioeconomic benefits associated with the 30 ppm sulphur limit for gasoline, sulphur levels greater than 30 ppm cannot be recommended. Arguments can be made in favour of both implementation options A.1 and A.2. Option A.2 may reduce disruption and dislocation in the petroleum industry by providing a longer period in which to comply. However, it does not provide a maximum level of protection to Canadians in regions outside the Southern Ontario-Montreal corridor until the year 2005. In addition, it may have a negative impact on low emission and fuel efficient vehicles operating in high sulphur regions. Option A.1 is recommended because it provides the maximum health benefits to all Canadians in the shortest time frame.

Sulphur in Diesel

With the implementation of the federal Diesel Fuel Regulations, which limited sulphur levels in diesel used in on-road vehicles to 500 ppm as of January 1, 1998, the average sulphur level in low sulphur diesel in Canada is 270 ppm. The average for the remaining diesel pool is over 2,200 ppm. The findings of the Atmospheric Science Expert Panel indicate that limits on sulphur levels in diesel, particularly off-road diesel, could result in substantial reductions in ambient air levels of sulphates, fine particulates and sulphur dioxide (see Table 1).

The Health and Environmental Impact Assessment Panel estimated that a 400 ppm limit for off-road diesel could produce health benefits worth $2.9 billion in the seven Canadian cities examined over a twenty year period. Likewise, the Panel estimated that the 50 ppm limit for on-road diesel could produce health benefits worth $1.2 billion in the seven Canadian cities over a twenty year period (see Tables 2 & 3).

When a benefit-cost analysis was conducted on the various diesel scenarios, it was determined that the health benefits associated with the 400 ppm off-road diesel standard outweighed the compliance costs by a 2:1 ratio.

Action Recommended for Sulphur in Diesel

The Government Working Group has recommended that the sulphur in diesel levels should be considered in early 1999 when several uncertainties respecting costs and benefits have been addressed. Given the health and economic benefits that could result from the reduction of sulphur levels in diesel, particularly for off-road diesel, it is recommended that new sulphur limits should be established for diesel before the year 2000, and that those limits should maximize the health benefits for residents across the country.

Conclusions:

Given the compelling health and economic benefits associated with the 30 ppm sulphur limit for gasoline, sulphur levels greater than 30 ppm cannot be recommended. Implementation option A.1 is recommended because it provides the maximum health benefits to all Canadians within the shortest time frame.

Given the health and economic benefits that could result from the regulation of new sulphur levels for diesel, particularly for off-road diesel, it is recommended that new sulphur standards should be established for diesel before the year 2000, and that those standards should maximize health and economic benefits for residents across the country.

Contact Name:

Kim Perrotta

Environmental Protection Office, Toronto Public Health

(416) 392-6788

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Table 1:Reductions in Ambient Air Levels by 2020, Across Seven Canadian Cities:

Table 2:Avoided Health Outcome Over Period 2001-2020, Different Sulphur Scenarios, Total for Seven Canadian Cities:

Table 3:Monetary Value of Avoided Health Outcomes Over Period 2001-2020, Different Sulphur Scenarios, Total For Seven Cities, ($ Billions)

Table 4:Proposed Actions for Sulphur in Fuel

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(Communication dated June 25, 1998,

addressed to the Chair, Government Working Group,

Sulphur in Gasoline and Diesel Fuel, Environment Canada,

from the Medical Officer of Health)

Introduction:

This report contains comments on the "Preliminary Report of the Government Working Group on Sulphur in Gasoline and Diesel" as promised in my letter of May 28, 1998.

Staff in the Environmental Protection Office in Public Health have consulted with staff in Toronto Works and Emergency Services in the preparation of these comments. The documents received from the Government Working Group are listed in the appendix attached to this report.

Members of the Government Working Group are aware that air quality is a public health priority for the new City of Toronto. The following reports on air quality have been prepared by Public Health and adopted by City Council over the past two years:

• "Outdoor Air Quality in Toronto and Respiratory Health", August 1996;
• "Actions With Respect to Vehicle Emissions", August 1996;
• "Emergency Plan Options for Outdoor Air Quality Episodes", August 1996;
• "Impact of Emissions from the Main Sewage Treatment Plant and Lakeview Generating Station", August 1996;
• "Global Climate Change", June 1997;
• "Catching Your Breath -- A Corporate Model For Clean Air", July 1997;
• "Burning of Waste Oil -- Health and Environmental Impacts", May 1998; and
• "Corporate Smog Alert Response Plan -- 1998 Implementation Plan", May 1998.

Background:

In 1996, Environment Canada established a process to establish limits for sulphur in gasoline and diesel in collaboration with other federal departments, provincial governments, industry and non-governmental organizations in response to recommendations from the Canadian Council of Ministers of the Environment (CCME). As part of the process, three expert panels were struck to prepare reports on the issues related to a variety of proposed sulphur levels for gasoline and diesel: the Atmospheric Science Expert Panel, the Health and Environmental Impacts Assessment Panel, and the Cost and Competitiveness Assessment Panel. Those reports were released in the fall of 1997 and are referenced in the appendix.

A Government Working Group, with representatives from five federal departments and six provincial ministries, has prepared a preliminary report, "Setting a Level for Sulphur in Gasoline and Diesel", which summarizes and analyses the expert reports and other background information, and presents a variety of options for government action. That report was released in May 1998 for public comment. The final report is scheduled to be completed this summer and is expected to be tabled by the federal Ministers of Environment at a CCME meeting in the fall of 1998.

The preliminary report presents five options for action on sulphur levels in gasoline:

Option A.1The establishment of a 30 ppm annual average and an 80 ppm maximum effective across Canada on January 1, 2002;

Option A.2The establishment of a 30 ppm annual average and an 80 ppm maximum effective in the Southern Ontario-Montreal corridor on January 1, 2002, and in the rest of Canada on January 1, 2005;

Option A.3The establishment of a 30 ppm annual average and an 80 ppm maximum effective in the Southern Ontario-Montreal corridor and Lower Fraser Valley on January 1, 2002, with sulphur levels frozen at 1994 levels in the rest of Canada;

Option BThe establishment of a 150 ppm annual average and a 200 ppm maximum effective across Canada effective January 1, 2002;

Option CAction on sulphur levels in gasoline is deferred. Future standards to match the least restrictive fuel requirements of the Tier 2 vehicle standard in the United States.

The Government Working Group has recommended that sulphur levels in diesel should be considered in early 1999 when several uncertainties respecting costs and benefits have been addressed.

Comments:

Recommendation #1:It is recommended that sulphur levels in gasoline should be set at an annual average of 30 ppm and a maximum of 80 ppm across Canada effective January 1, 2002 as outlined by Option A.1.

The worldwide trend is towards lower sulphur levels in gasoline. Currently, the average level of sulphur in gasoline is higher in Canada, at 340 parts per million (ppm), than in many other developed nations. Within Canada, the sulphur levels are highest in Ontario with an average of 540 ppm. In the United States, the average sulphur level is 295 ppm in the areas to which the Federal government's Reformulated Gas Program (RFG) does not apply. The average sulphur level is lower in the areas to which the Reformulate Gas Program does apply, and is expected to decrease to 150 ppm, in the next few years with the implementation of Phase 2 of the Reformulated Gas Program. In Japan, sulphur levels in gasoline are limited to a maximum of 100 ppm. The European Union has agreed to apply a 150 ppm sulphur limit to gasoline in the year 2000, and its Council of Ministers have proposed a 50 ppm limit for the year 2005.

The 30 ppm limit is technically achievable. Sulphur levels in gasoline have been capped at an average of 30 ppm or a maximum of 40 ppm since 1996 in the State of California.

The 30 ppm sulphur level would produce substantial reductions in the ambient levels of a wide range of air pollutants. Sulphur affects the efficiency of current and advanced emission control technologies on vehicles. Therefore, when sulphur levels in gasoline are reduced, vehicle emissions of hydrocarbons, carbon monoxide, and nitrogen oxides are reduced, as well as sulphur dioxide and sulphates. The Atmospheric Science Expert Panel has calculated that the 30 ppm sulphur limit in gasoline would produce substantial reductions in ambient air levels of carbon monoxide, nitrogen dioxides, fine particulates, sulphur dioxide and sulphates in all of the seven Canadian cities examined. For example, it was estimated that the 30 ppm sulphur level would reduce carbon monoxide levels by 10-68 ppm in the seven Canadian cities examined (i.e. Halifax, Saint John, Montreal, Toronto, Winnipeg, Edmonton, Vancouver) by the year 2020. The greatest reductions for all air pollutants examined in relation to gasoline were predicted for the City of Toronto.

The 30 ppm sulphur level provides the greatest health and socioeconomic benefits for Toronto and Canada as a whole. The Health and Environmental Impact Assessment Panel has demonstrated that reductions in premature mortality, chronic respiratory disease, hospital admissions and asthma symptoms days would be greatest with the 30 ppm sulphur limit. Over a twenty year period, the Panel has estimated that 1,352 premature deaths, 4,770 chronic respiratory disease cases, 848 cardiac hospital admissions, 517,000 asthma symptom days, 17,900,000 acute respiratory symptoms, and many other health effects, could be avoided in the seven Canadian cities with the establishment of a 30 ppm sulphur level in gasoline. The Panel has indicated that these health benefit numbers underestimate the true extent of the health benefits that could result from a lowering of the sulphur limit in gasoline because they do not include the health effects that result from the independent action of toxics such as carbon monoxide.

In the year 2001, in the Toronto area, the 30 ppm sulphur limit could prevent 136 cases of chronic respiratory disease, 513,571 cases of acute respiratory symptoms, and many other health effects. The monetary value of these avoided health effects has been calculated to be $205million. This compares with estimates of $165million in health benefits with a 150 ppm sulphur limit and $92 million in health benefits with a 360 ppm limit.

When the monetary benefits of the avoided health outcomes were calculated for the seven Canadian cities over a twenty year period, it was estimated that the 30 ppm sulphur limit was worth $5.2 billion in health benefits with a 3% discount for inflation built in. This can be compared to health benefits worth $3.9 billion with a 150 ppm limit and $2.1 billion with a 360 ppm limit.

While the compliance costs associated with the 30 ppm sulphur standard are substantial, the health benefits are much greater. The Cost and Competitiveness Assessment Panel estimated that it could cost the refining industry a maximum of $1.8 billion in one-time capital costs and $119million in annual operating costs to comply with the 30 ppm sulphur standard for gasoline. It was estimated that the 30 ppm standard would increase the cost of gasoline by approximately $0.01 per litre. It was also determined that the 30 ppm sulphur limit could threaten the viability of 3 or 4 of the 17 refineries currently operating in Canada.

However, when a benefit-cost analysis was conducted, the health benefits outweighed the compliance costs by a 2:1 ratio for Canada as a whole. In Ontario, where sulphur levels are the highest, a greater proportion of vehicles are gas powered, and the population is the greatest, the health benefits outweighed the compliance costs by a 4:1 ratio. The health benefits, when calculated for the entire population of Ontario over a twenty year period, were estimated at $6.14 billion.

While the health benefits will be shared by Canadians across the country, albeit disproportionately by those living in areas with the poorest air quality, the compliance costs may be born inequitably by workers dislocated from refineries that could close as a result of the 30 ppm sulphur standard. To ameliorate the effects of this dislocation, the federal government should establish an environmental income replacement program, complete with re-education funds, to assist workers who may be affected.

Gasoline with higher sulphur levels reduces the efficiency and performance of low emission vehicles and high fuel efficiency vehicles. The Association of International Automobile Manufacturers of Canada and the Canadian Vehicle Manufacturers' Association have indicated that vehicle manufacturers cannot continue to improve vehicle emissions or fuel efficiency without commensurate improvements in the quality of vehicle fuels. These Associations have indicated that fuels with higher sulphur levels can adversely affect the efficiency and performance of emission control technologies, particularly those designed for low emission vehicles. They also indicate that new technologies designed to improve vehicle fuel efficiency are more susceptible to sulphur than current technologies. These views have been expressed by staff in the United States Environmental Protection Agency (US EPA) as well. In a May 1998 report entitled, "Staff Paper on Gasoline in Sulphur Issues", the US EPA indicates that:

"While sulphur has a large impact on emissions from current low-emission vehicles, technological advances are also being made to improve the fuel efficiency of the nation's vehicles. Gasoline direct injection engines and fuel cells are two of the advanced power plants being developed. Both of these technologies may be more sensitive to sulphur than current vehicles."

The vehicle manufacturing associations in the United States have petitioned the US EPA to establish a year round limit on sulphur in gasoline for the entire gasoline pool "that is as low as practicable but in no case greater than 40 ppm per gallon by weight, or ... in no case greater than 30 pm annual average by weight with a per gallon cap of 80 ppm." They are asking that the US EPA to promulgate a sulphur regulation and to make it effective "as rapidly as possible".

Implementation Option A.1 provides the greatest health benefits in the shortest time frame.

Implementation options A.1 and A.2 both have arguments in their favour. Option A.2, which provides a longer time frame for the introduction of the 30 ppm limit to the rest of Canada, may be less disruptive to the petroleum industry. However, it provides a lesser level of health protection to Canadians outside of the Southern Ontario - Montreal corridor for an additional three years. It may also have a negative impact on low emission vehicles and high fuel efficiency vehicles operating in higher sulphur regions. Option A.1 is recommended because it provides the maximum health benefits to all Canadians in the shortest time frame, while eliminating the technological problems associated with high sulphur fuels in low emission vehicles.

Recommendation #2:It is recommended that sulphur limits for diesel, particularly for off-road vehicles, should be established before the year 2000, and that those standards should maximize the health benefits for residents across Canada.

Substantial health benefits could result from a 400 ppm sulphur limit for off-road diesel and from a 50ppm sulphur limit for on-road diesel. With the implementation of the federal Diesel Fuel Regulations, which limited sulphur levels in on-road diesel at 500 ppm as of January 1, 1998, the average sulphur level in low sulphur diesel in Canada has decreased to 270 ppm. The average for the remaining diesel pool is over 2,200 ppm.

The Atmospheric Science Expert Panel has indicated that sulphur limits for diesel could result in substantial reductions in ambient air levels of sulphates, fine particulates and sulphur dioxide. For example, the Panel estimated that the 400 ppm sulphur limit for diesel used in off-road vehicles could reduce ambient air levels of sulphur dioxide by 0.11 to 1.09 ppb in the seven Canadian cities by the year 2020.

The Health and Environmental Impact Panel has demonstrated that the 400 ppm limit for off-road diesel could reduce chronic respiratory cases by 2,660 and acute respiratory symptoms by 10,000,000 in the seven Canadian cities over the twenty year period from 2001 to 2020, while the 50 ppm limit for on-road diesel could reduce chronic respiratory disease cases by 1,120 and acute respiratory symptoms by 4,220,000.

The Panel has estimated that the 400 ppm limit for off-road diesel, when calculated over a twenty year period, could produce health benefits worth $2.9 billion for the seven Canadian cities, while the 50ppm sulphur limit for on-road diesel could produce health benefits worth $1.2 billion. When a benefit-cost analysis was conducted, it was determined that the health benefits associated with the 400 ppm off-road diesel standard outweighed the compliance costs by a 2:1 ratio.

The Government Working Group has recommended that the sulphur in diesel levels should be considered in early 1999 when several uncertainties respecting costs and benefits have been addressed. Given the health and socioeconomic benefits that could result from action on sulphur levels in diesel, particularly for off-road diesel, it is recommended that the federal government should establish new sulphur standards for diesel before the year 2000, and that those standards should maximize the health and socioeconomic benefits for all Canadians.

Conclusions

Environment Canada, and the other departments, ministries and organizations that have been involved in the development of Panel reports and the Government Working Group report should be commended. The sulphur in fuel issue has been subject to extensive research, comprehensive analysis and broad consultation. The preliminary report and background documents provide compelling health and socioeconomic evidence in support of the 30 ppm limit for gasoline and the 400 ppm limit for off-road diesel. The Government Working Group should move quickly to establish sulphur standards for fuel which maximize the health benefits for all Canadians.

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Public Health Division staff gave a presentation to the Board of Health in connection with the foregoing matter.

Councillor Jack Layton, Don River, appeared before the Board of Health in connection with the foregoing matter, and filed a copy of his presentation in regard thereto.

(Appendix attached to the letter dated June 25, 1998, to the Government Working Group by the Medical Officer of Health, referred to in the foregoing report was forwarded to all Members of Council with the agenda of the Board of Health for its meeting on July 27, 1998, and a copy thereof is on file in the office of the City Clerk.)

(City Council on July 29, 30 and 31, 1998, had before it, during consideration of the foregoing Clause, the following report (July 29, 1998) from the City Clerk:

The Environmental Task Force at its meeting on July 28, 1998, considered a memorandum dated July22, 1998, from Councillor Jack Layton, Chair, Environmental Task Force, together with a copy of the report dated July 10, 1998, from the Medical Officer of Health, headed "Air Quality and a Federal Standard for Sulphur in Fuel".

The Environmental Task Force recommended that:

(1)City Council be advised that the Environmental Task Force endorses the recommendations, as adopted by the Board of Health at its meeting of July 27, 1998, regarding the report from the Medical Officer of Health, headed "Air Quality and a Federal Standard for Sulphur in Fuel";

(2)City Council request other Municipal Councils in Ontario to endorse the recommendations, as adopted by the Board of Health at its meeting of July 27, 1998;

(3)City Council establish a high level delegation of Councillors and appropriate staff, including the Mayor, if possible, to make representations to the relevant Ministers at both the federal and provincial levels;

(4)the City Solicitor forward a copy of the report requested by the Board of Health, regarding the feasibility of enacting a Municipal By-law to control sulphur levels in gasoline and diesel fuel in the City, to the Environmental Task Force for information; and

(5)the City Clerk forward a copy of the report (July 13, 1998) of the Medical Officer of Health and a copy of Council's decision, to all Provincial and Federal Ministers.

(Communication dated July 22, 1998, addressed to

the Environmental Task Force, from

Councillor Jack Layton, Chair, Environmental Task Force)

That the Environmental Task Force endorse the following recommendations, including Recommendation No. (1) made by the Medical Officer of Health to the Toronto Board of Health at its meeting on July 27, 1998, and advise City Council accordingly.

Recommendations:

It is recommended that:

(1)the Federal Minister of Environment:

(a)establish sulphur limits for gasoline at an annual average of 30 ppm and a maximum of 80 ppm across Canada, effective January 1, 2002, as outlined by option A.1 in the report of the Government Working Group;

(b)establish sulphur levels for diesel, particularly for off-road vehicles, that maximize the health benefits for residents across Canada before the year 2000;

(c)establish an environmental income replacement program, complete with re-education funds, to assist workers dislocated by plant closures that may result from sulphur standards set for gasoline and diesel; and

(2)City Council request other Municipal Councils in Ontario to endorse Recommendation No.1.)

(City Council also had before it, during consideration of the foregoing Clause, a communication (July 27, 1998) from Ms. Cathy Walker, Director, CAW Health & Safety Department, CAWTCA Canada, expressing concerns regarding the air quality in Toronto; and requesting City Council to endorse the report of the Medical Officer of Health.)

3

Council Representation on the Board of Health

(City Council on July 29, 30 and 31, 1998, adopted this Clause, without amendment.)

The Board of Health recommends that :

1. effective May, 1999 Council representation on the Board of Health, which is presently seven members of Council, be reduced to six members of Council and that the remaining Board composition consist of one elected school board representative and six citizen members to a total membership of 13; and
2. the City Solicitor be requested to prepare the necessary By-law if Council increases or decreases the membership composition on the Board of Health.

The Board of Health reports for the information of Council having:

(1)adopted Option (iv) contained in the report (July 7, 1998) from the Medical Officer of Health and in so doing established a School Health Subcommittee of the Board of Health with representation from all school boards and private schools with a mandate to make recommendations to the Board of Health on school health policy and advocacy issues, and adopted the report as so amended; and

(2)requested the Medical Officer of Health to report to the Board of Health in the Fall of 1998 on the present staff organization in place to relate to school boards, and on staff's working relationship with the Children's Advocate.

The Board of Health submits the following report (July 7, 1998) from the Medical Officer of Health:

Purpose:

This report outlines options for School Board representation on the Board of Health and mechanisms for liaison between Public Health staff and School Board staff.

Source of Funds:

Not applicable.

Recommendations:

It is recommended that:

(1)the Board of Health choose one of the options for School Board representation detailed in this report; and

(2)the Medical Officer of Health approach the public and separate school boards to establish management committees to address school health issues and services.

Council Reference/Background/History:

On May 12, 1998, the Board of Health requested staff to review the proposal to establish four Advisory Committees (Food Policy Council; Animal Services; School Health; and Substance Abuse/Alcohol Advisory) and report further addressing the following issues:

(1)purpose of each committee: e.g. mandate; Terms of Reference; composition - board members/citizen members/staff members; identification of need;

(2)expected outcomes of each committee;

(3)analysis of potential duplication or overlap of its mandate in other City of Toronto agencies, boards and committees (ABC's); and

(4)designation as an internal or external committee, and its connection to the Board of Health.

This report addresses these issues relating to the proposed School Health Advisory Committee.

Comments:

Programs that focus on children and youth are an integral building block of Public Health. Primary prevention early in the life cycle has been proven effective in creating a healthy beginning to a healthy lifestyle. Early interventions are enshrined identified in the goals of the mandatory guidelines of the Health Protection and Promotion Act. Therefore, schools are one of the most important venues by which Public Health reaches children and youth.

The six former municipal Boards of Health had a variety of structures to establish and maintain relationships with school boards in their jurisdictions. In some cases, specific seats for school trustees were allocated on the Board. Additionally, one Board created a school health subcommittee and several Boards had high-level management committees that met regularly to identify and resolve issues.

The value of school trustees sitting on the Board of Health includes:

(a)their experience with the issues that have an impact on children and youth;

(b)increased understanding of public health issues leading to increased awareness on the school board; and

(c)their position on another Board which allows for collaborative advocacy on behalf of children and youth.

The former City of Toronto Board of Health School Health Subcommittee did not work optimally as most issues requiring resolution or collaboration were not policy related; rather they were program related and operational in nature. However, the high level management committees of the other boards did work well in facilitating the implementation of programs and the resolution of operational issues. Policy and advocacy issues which required Board decisions were sent from the senior management committee members to their respective Boards.

Based upon the collective past experiences of the Boards of Health, high level management committees should be established with the two larger School Boards and a high level manager should be identified as a lead contact for the French Language Board. These committees would address school health issues such as curriculum support and services to students in areas such as immunization, TB, sexual health, substance abuse, nutrition and dental health. Given the complexity of issues of amalgamation at the Toronto District School Board, it would make sense initially to have at least two committees.

As there are only 13 positions on the Board of Health (including 7 members of Council and 6 citizens) and 4 School Boards, it is not feasible for each to be represented on the Board of Health. The Toronto District School Board has approximately 304,063 students, the Toronto Catholic District School Board 102,243 students, the French School Board 1,930 students and the French Catholic School Board has 1,596 students. Private schools number about 150 and have approximately 35,000 students. There is no one board for private schools.

The Board has several options:

(i)continue to formally invite the two larger school boards to have a trustee assigned to the Board as a regular attendee with a voice but no vote;

(ii)when the term of the present councillors is up, designate one of the current councillor positions for a school board trustee and designate the spot for the school board with the majority of students (invite the other boards to assign a trustee to attend regularly with voice but no vote); and

(iii)same as (ii), rotate the two larger school boards through the spot on an 18 month basis.

Conclusions:

Public Health and school boards have had long and fruitful relationships. There are many examples, such as child nutrition, which demonstrate the advantage of these relationships. The above options detail the mechanisms by which these relationships may continue to be fostered in the future.

Contact Name:

Liz Janzen, Regional Director, Toronto Office

Tel: 392-7458, Fax: 392-0713

4

Energy Efficiency in Buildings and Active Transportation

(City Council on July 29, 30 and 31, 1998, adopted this Clause, without amendment.)

The Board reports having supported the actions taken by the Federation of Canadian Municipalities with respect to energy efficiency in buildings and sustainable transportation strategies as outlined in two issues of its 20% Club News , and forwards this matter to Council for information.

The Board of Health submits the following communication (May 11, 1998) from Councillor John Hachey, City of Lachine, Honorary Chair, Federation of Canadian Municipalities:

We enclose two issues of the 20% Club News. They focus respectively on:

-energy efficiency in buildings; and

-active transportation.

I hope you enjoy reading them.

(A copy of the 20% Club News, referred to in the foregoing communication, was forwarded to all Members of Council with the agenda of the Board of Health for its meeting on July 27, 1998, and a copy thereof is on file in the office of the City Clerk.)

5

Queen Elizabeth II Sesquicentennial

Scholarship Award in Public Health Nursing

(City Council on July 29, 30 and 31, 1998, adopted this Clause, without amendment.)

The Board of Health reports having approved the awarding of this year's Queen Elizabeth II Sesquicentennial Scholarship in Public Health Nursing in the amount of $5,000 to Riffaat Mamdani as recommended by the Faculty of Nursing, University of Toronto, and forwards this matter to Council for its information. Funds are available from the Toronto Sesquicentennial Scholarship Trust Fund 6118.

The Board of Health submits the following communication (June 11, 1998) from Pamela Khan, Co-Chair, Awards Committee, Faculty of Nursing, University of Toronto:

I am writing to advise you of our selection for this year's recipient of the Queen Elizabeth II Sesquicentennial Scholarship in Public Health Nursing. The Awards Committee met recently and is recommending Riffaat Mamdani as this year's recipient.

Riffaat has maintained good standing in the program and currently ranks in the top half of her class. She speaks Khachi and Gujarati and has some familiarity with three other languages. Within the last few years she has demonstrated an interest in serving different populations. She has participated in community development in Guyana, South America, and in serving the youth of her own community as Director of the Ja'ffari Youth Group. Through her activities she has displayed a proactive leadership style which has focused especially on multicultural issues, and particularly issues related to women and to families.

Riffaat claims a strong interest in community health and community development and her activities to date admirably support that claim. We are very pleased to recommend Ms Mamdani for your award.

Please find enclosed a copy of the application submitted by Ms Mamdani. We will await your approval of our selection before notifying the recipient.

Respectfully submitted,

JOHN FILION,

Chair

Toronto, July 27, 1998

(Report No. 10 of The Board of Health, including additions thereto, was adopted, without amendment, by City Council on July 29, 30 and 31, 1998.)