This report provides an update on the H1N1 influenza pandemic in Toronto to date and the current public health response by federal and provincial governments and Toronto Public Health (TPH).

The Board of Health directed that:

1.         The provincial government be requested to raise social assistance rates based on the real cost of healthy living, including nutritious food, and indexed annually to reflect inflation.

2.         The Chair of the Board of Health and the Medical Officer of Health, together with the Association of Local Public Health Agencies, and representatives from the “Do the Math” Campaign and the “Put Food in the Budget” Campaign, be requested to meet with the Minister of Community and Social Services, the Minister of Children and Youth Services and the Minister of Health Promotion, to urge them to ensure access to safe, nutritious and culturally-acceptable food for all Ontarians and to link the  results of the Nutritious Food Basket survey across Ontario with the implementation of Breaking the Cycle: Ontario’s Poverty Reduction Strategy and the ongoing review of social assistance, in accordance with the consultation requirements noted in the Poverty Reduction Act (2009).

3.         The Chair of the Board of Health and the Medical Officer of Health request that the President and Chief Executive Officer and the Director of Surveillance and Epidemiology of the Ontario Agency for Health Protection and Promotion (OAHPP) explore the development of a long-term system to monitor access to safe, nutritious and culturally-acceptable food.

4.         This report be forwarded, for support and action, as appropriate, to the following key stakeholders: the City of Toronto’s Community Development and Recreation Committee; the General Managers of Shelter, Support and Housing Administration, Children’s Services, Employment and Social Services, Long-term Care Homes and Services, and Parks, Forestry and Recreation; the Ontario Ministers of Health Promotion, Community and Social Services, Children and Youth Services and Agriculture, Food and Rural Affairs, Agriculture and Agri-Food Canada; the Ontario Agency of Health Protection and Promotion; the Office of Nutrition Policy and Promotion at Health Canada; the Association of Local Public Health Agencies; the Ontario Public Health Association; Ontario Boards of Health; the Association of Ontario Health Centres; the Ontario Society of Nutrition Professionals in Public Health and Dietitians of Canada.

5.         The recommendations from Jonah Schein, STOP Community Food Centre, be referred to the Medical Officer of Health for consideration in the advocacy efforts he is engaged in with partners working on anti-poverty strategies.

The Board of Health directed that:

1.         The Ontario Minister of the Environment be requested to ask Metrolinx to defer purchasing diesel locomotives for any part of the proposed Georgetown South Expansion and Air-Rail Link until the following information is made available for public consideration and comment, and review by the Minister:

a.         all additional studies, analyses and public consultation related to the development of a revised mitigation plan to address risks to human health, and an ambient air monitoring and reporting plan, as required by the Ontario Minister of the Environment in his October 5, 2009 “Notice to proceed with transit project subject to conditions”;

b.         a Health Impact Assessment as part of Condition 5 (to “conduct further studies and analyses in order to supplement the information contained in the Environmental Project Report (EPR) related to predicted human health risks”), conducted in consultation with the Medical Officer of Health, which examines the distribution in the community of risks and benefits from the proposed rail expansion, and takes into account pre-existing gradients in health status;

c.         a monitoring program for ultrafine particulate matter (PM0.1) that characterizes baseline concentrations and concentration gradients; and

d.         the results and any advice from the planned GO System Electrification Study.

2.          Metrolinx be urged to strengthen the planned GO System Electrification Study by:

a.         developing a risk analysis framework for integrating the environmental, health, social and economic impacts associated with each train technology option that is explicit, and open to public review;

b.         broadening the assessment of health impacts associated with train technology options from the quantitative human health risk assessment (HHRA) approach used in the Georgetown South study to one that encompasses Health Impact Assessment (HIA) methods; and

c.         comparing the total cost of train expansion options between investing in electrification now versus use of Tier 4 compliant diesel technology as an interim strategy, with electrification later.

3.         The Ontario Minister of the Environment be requested to put the following information on the Environmental Registry in order to increase transparency and enforceability of the conditions specified in the Minister’s October 5, 2009 Notice regarding Metrolinx’ proposed train expansion:

a.         the health assessment, air monitoring, air modelling studies and mitigation plans, required in conditions 5, 7, 8, 11, 13 and 16; and

b.         the results of the GO System Electrification Study, given that condition 4 indicates that Metrolinx should make available to the public any consideration of the use of new technologies that become commercially available and that could reduce air emissions from the trains.

4.         The Environmental Commissioner of Ontario (ECO) be requested to give consideration to making a special report to the Speaker of the Assembly on the public process employed by Metrolinx, and the environmental significance of technology choices such as diesel expansion versus electrification of the commuter rail system.

5.         This report be forwarded to:

a.         the Clean Train Coalition, the Environmental Health Association of Ontario, the Mount Dennis Community Association and the Weston Community Coalition; 

b.         the Medical Officers of Health for Halton and Peel Regions; 

c.         the Ontario Ministers of Health and Long-Term Care, and Transportation

d.         the Toronto District School Board and Toronto Catholic District School Board; 

e.         the Environmental Commissioner of Ontario;

f.          the Premier of Ontario;

g.         the Members of Parliament and Members of Provincial Parliament for the Metrolinx Study Area; and,

h.         the Federal Ministers of the Environment and Transportation.

6.         This report be forwarded to the Parks and Environment Committee for information.

7.         The Medical Officer of Health be requested to prepare a response to the November 13, 2009, correspondence from Metrolinx and to identify the extent to which the Medical Officer of Health’s recommendations are addressed, including how noise impacts could be dealt with in the electrification study, and to make this response available to members of the Board of Health, community groups and deputants.

8.         The Chairs of the Board of Health and the Parks and Environment Committee be requested to consider holding a public forum to be held in the Council Chamber as soon as possible; and that they invite the Minister of the Environment or his designate, and the President and CEO of Metrolinx to attend this meeting and hear more speakers on this issue.

Metrolinx is proposing a significant expansion of regional passenger rail service starting in 2015 and resulting in an almost ten-fold increase in the number of trains on the Georgetown South corridor and a separate Air-Rail Link between Pearson Airport and Union Station.  The project has been subject to public review under Ontario’s new Transit Project Assessment Process for the past six months.

Throughout this public review, the Medical Officer of Health (MOH) and many of the communities along the rail corridor have expressed concern over the adverse air quality and human health impacts that Metrolinx predicts will occur from this rail expansion.  The MOH’s recommendations have included further studies and using electric locomotives instead of diesel.

On October 5, 2009, Ontario Environment Minister John Gerretsen concluded the Transit Project Assessment Process by permitting Metrolinx to continue with the proposed project, under certain conditions, such as requiring certain locomotives to be compliant with American Tier 4 diesel standards.

The impact of the Minster’s conditions on the predicted air quality and health impacts of the diesel rail expansion have not yet been determined. This report requests the Environment Minister to ask Metrolinx to defer purchasing diesel trains for the service expansion in the Georgetown South corridor until the further studies specified in the Minister’s notice of conditions, as well as the proposed electrification study, have been completed and made available for full public consultation and review.  Based on existing information, electrification of the proposed rail line continues to be the mitigation option that most clearly addresses the predicted air quality and health impacts. Whether other mitigation options could reduce these air quality and health impacts to an acceptable level remains to be demonstrated. 

Toronto Public Health led a review of Toronto’s idling control bylaw to determine how it could be improved. The review considered the benefits of reducing idling of vehicles, idling control bylaws in other jurisdictions, reasons why people idle, and information gathered during stakeholder consultations.

Consultation with stakeholders indicated that the bylaw could be more effective if it was easier to understand and easier for the City to enforce. Suggestions for improvement included decreasing the allowed idling time, clarifying the language in the bylaw, removing some of the exemptions, and strengthening enforcement.

A revised bylaw would offer the opportunity to renew efforts to reduce idling in Toronto. Education and outreach could increase public knowledge about the impact of idling on greenhouse gas emissions and target specific areas or sectors which are a consistent source of complaints.

The Board of Health:

1.         endorsed the recommendations in the report (October 2009) from the Toronto Bed Bug Project Steering Committee;

2.         requested the Toronto Bed Bug Project to provide an annual report in the fall of 2010 on progress to date;

3.         reiterated its request to the Government of Ontario to fund bed bug control initiatives for vulnerable populations as part of their poverty reduction strategy;

4.         requested the Minister of Health and Long-Term Care to provide targeted funding for bed bug control initiatives for low income and vulnerable populations as part of Ontario’s poverty reduction strategy;

5.         requested the City Manager to:

a.         recognize bed bug control as a City-wide issue involving multiple City divisions and to consider the appointment of a multi-divisional City-wide project manager for bed bug control initiatives;

b.         ensure that staff from all necessary divisions and agencies, boards and commissions are assigned to participate in the development and implementation of a comprehensive strategy to manage bed bugs in Toronto in collaboration with key community partners;

6.         requested the Medical Officer of Health to:

a.         encourage all rental housing operators to adopt a Bed Bug Management Protocol based on the best practices outlined in the report (November 3, 2009) from the Medical Officer of Health and to share this with their tenants; and

b.         request that all new rental projects file a Bed Bug Management Protocol with their application; and

forwarded a copy of this recommendation to the City’s Affordable Housing Office; and

7.         directed that copies of this report be forwarded to the Toronto Community Housing Corporation, The Greater Toronto Apartment Association and the Ontario Non Profit Housing Association for information.

The Board of Health recommends that:

1.       City Council approve an increase of $25.4 thousand gross and $0.0 net budget to Toronto Public Health’s 2009 Operating Budget and the addition of one temporary position to reflect confirmed 2009 funding from the Heart and Stroke Foundation of Canada, the lead agency for Coalitions Linking Action and Science for Prevention (CLASP) funding.

The Board of Health recommends that:

1.         City Council direct that the City of Toronto enter into an affiliation agreement with the University of Toronto to describe and clarify the relationship between the two organizations regarding their common interests in the education of health professionals in public health and related sciences, and research and research training.

2.         City Council grant authority to the Medical Officer of Health to execute an affiliation agreement with the University of Toronto in the form or substantially in the form of the agreement in Attachment 1 to the report (November 3, 2009) from the Medical Officer of Health.

The Board of Health recommends that:

1.         City Council increase the Toronto Public Health 2009 Operating Budget by $547.1 thousand gross and $0.0 net which is an estimate of the total increase in 2009 salaries and benefits for the Medical Officer of Health (MOH) and Associate Medical Officer of Health (AMOH) that will be provided in the Funding Agreement to be issued by the Ministry of Health and Long-Term Care before the end of 2009.

2.         City Council authorize the City Manager to approve any further adjustment that may be required to the Toronto Public Health 2009 Operating Budget for 100 per cent provincial funds based on the MOH/AMOH Compensation Funding Agreement received from the Ministry of Health and Long-Term Care.

The Board of Health Budget Sub-Committee on November 5, 2009, considered a report (October 26, 2009) from the City Manager, addressed to the Board of Health, entitled “Budget Adjustment to the Toronto Public Health 2009 Operating Budget for the Medical Officer of Health/Associate Medical Officer of Health Compensation Initiative”.

This report provides an update to the Board of Health on the Toronto Public Health (TPH) Capital Budget variance for the nine-month period ended September 25, 2009.

Toronto Public Health spent $1.879 million or 33.1 percent of the 2009 approved cash flow of $5.670 million as of September 25, 2009.

The year-end capital expenditure is projected to be $3.398 million or 59.9 percent of the approved cash flow.

 •          Minutes of the Etobicoke/York Local Health Committee meeting held on February 5, 2009.

The Board of Health received, for information, the minutes of the Toronto/East York Local Health Committee meetings held on April 14, 2009, June 9, 2009 and September 15, 2009.

•           Minutes of the Toronto/East York Local Health Committee meeting held on April 14, 2009

•           Minutes of the Toronto/East York Local Health Committee meeting held on June 9, 2009

•           Minutes of the Toronto/East York Local Health Committee meeting held on September 15, 2009

Councillor Paula Fletcher advising that the South Riverdale Community Health Centre and the Ontario Healthy Schools Coalition have produced a “Clean Air Checklist” to help raise awareness about indoor air quality issues and assist teachers in improving the air quality in their classrooms.  The Checklist provides simple and easy suggestions for teachers and students who are seeking to contribute to environmental health.

The Board of Health recommends that:

1.         City Council approve the street vending location fees for 2010 for existing locations as set out in Attachment A to the report (November 10, 2009) from the Medical Officer of Health.

2.         City Council direct that the Vendor agreements be amended to allow the fee to be payable as follows:  10 percent of the annual amount payable on the last working day of April, and 30 percent of the annual amount payable on the last working day of each of June, August and October.

3.         City Council direct that the Toronto a la Cart pilot project:

a.         include new vending locations and fees as set out in Attachment B to the report (November 10, 2009) from the Medical Officer of Health; and

b.         offer the first right of refusal for the new approved locations to the eight current Toronto a la Cart vendors for the remaining term of their Licence Agreements.

4.         City Council approve the transfer of all authority with respect to the implementation and administration of the Street Food Pilot Projects previously delegated to the Medical Officer of Health to the General Manager, Economic Development, Culture and Tourism.

5.         City Council request the General Manager, Economic Development, Culture and Tourism, to:

             a.        continue efforts to expand healthy food options for existing food vendors; and

             b.        investigate, with the cart manufacturer, ways to improve the cart design.

6.         City Council approve the transfer of the recommended 2010 budget of $50,000 gross and $0 net for the pilot projects from Toronto Public Health to Economic Development, Culture and Tourism.

7.         City Council direct that amendments to Municipal Code Chapter 738 be made as required to implement the recommendations in this report, including:

a.         the requirement that the Toronto a la Cart owner shall personally operate the cart for a minimum of 70 percent of the hours of operation be reduced from 70 percent to 50 percent; and

b.         deleting the restriction that each Toronto a la Cart vendor may only employ up to three assistants; and

c.         revising the description of the Queen’s Park location in Schedule A to the report (November 10, 2009) from the Medical Officer of Health to read as follows: “Queen’s Park (City owned parkland) west side of Queen’s Park Crescent West at Hoskin Avenue (signalized intersection)”; and

d.         replacing as necessary all references to the “Medical Officer of Health” with “General Manager of Economic Development, Culture and Tourism” as the official with responsibility for the implementation and administration of the project; and

e.         adding the new Toronto a la Cart vending locations as recommended in this report; and

f.          adding the location fees for 2010 as set out in Attachments A and B to the report (November 10, 2009) from the Medical Officer of Health.

8.         City Council direct that amendments to Municipal Code Chapter 441 be made as required to add the location fees for 2010 as set out in Attachments A and B to the report (November 10, 2009) from the Medical Officer of Health.

9.         City Council grant permission to the Toronto a la Cart vendor temporarily relocated to the northwest corner of University Avenue and College Street to remain there for the remaining two years of the current Licence Agreement.

10.       City Council direct the Municipal Licensing and Standards Division to review the categories and fees for both Non-Motorized Refreshment Vehicles Licences and for Assistant’s Licences with a view to making it easier and more cost effective for Assistants to obtain licences.

At the request of the Executive Committee, Toronto Public Health designed and implemented a number of street food vending pilot projects to assess the impact of introducing new street foods at mobile vending carts.  “Toronto a la Cart”, a pilot project for new street food vendors, was approved for up to fifteen vendors and has been implemented with eight vendors.  Based on the first five months of operation, it is evident that location, product, and marketing are the critical success factors for street vending.  From a food safety perspective, this pilot demonstrates that food safety risk can be minimized if vendors implement the necessary precautions.  This report recommends location fee adjustments, new Toronto a la Cart locations, and modifications to the regulations governing this initiative.

In another pilot initiative, up to 15 existing hot dog and sausage vendors were invited to add new healthier foods to their carts.  However, after two attempts to find interested vendors, there were no project applicants.  This report concludes that the cost and the limited variety of allowable foods made the project unattractive to these vendors.

Staff also investigated the potential of implementing healthy street food pilots with appropriate not-for-profit organizations.  Although there is support among these non-governmental organizations for the street food vending initiatives, all agree that without financial assistance it is not possible for not-for-profit organizations to participate at the current time.

This report requests that the administrative responsibility for the street food vending pilot projects be transferred from Toronto Public Health to Economic Development, Culture and Tourism division starting in January 2010, and that the recommended funding of $50,000 gross and revenue in 2010 also be transferred to Economic, Development, Culture and Tourism.

The Board of Health recommended to the Budget Committee, for consideration during the 2010 budget process, that:

1.         City Council approve a Toronto Public Health 2010 Operating Budget request of  $219,885.8 thousand gross / $44,792.9 thousand net as summarized in Table 1, “2010 Operating Budget Request”.

2.         City Council approve the list of budget adjustments included in Table 3, “Summary of 2010 Base Budget Changes from 2009 Operating Budget” to the report (November 12, 2009) from the Medical Officer of Health, totalling a decrease of $2,622.7 thousand gross and an increase of $994.3 thousand net.

3.         City Council approve the recommended service reduction options as summarized in Table 4, “Summary of 2010 Service Reduction Options” of this report totalling a budget reduction of $1,005.2 thousand gross and $251.4 thousand net expenditures to move towards the City’s target of a five percent net decrease from the 2009 Operating Budget.

4.         City Council approve one 2010 New and Enhanced Service for the Investing in Families Program with an increase of $874.2 thousand gross / $0 net that is funded by Toronto Employment and Social Services.

5.         City Council continue to invest sufficient municipal funds to maintain and strengthen public health services in Toronto as recommended by the Walker expert panel and the Campbell commission, and to leverage 75 percent provincial funding to promote and protect the health of the Toronto population.

 The Board of Health requested that the Ministry of Health Promotion continue to fund the Children in Need of Dental Treatment (CINOT) Expansion program at 100 percent in 2010 in order to determine a more accurate and reliable budget and reduce budget pressure to municipalities.

This report outlines the Toronto Public Health (TPH) 2010 Operating Budget request.

The 2010 Operating Budget request totals $219,885.8 thousand gross / $44,792.9 thousand net. This request is $1,748.5 thousand gross or 0.8 percent below and $994.3 thousand net or 2.3 percent above the 2009 Operating Budget.  Options for reductions to the request are provided for the Board of Health’s consideration to help achieve the City’s direction for budget cuts.