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Agenda |
Regular |
Board of Health |
Meeting No. | 31 | Contact | Candy Davidovits, Committee Administrator | |
Meeting Date |
Tuesday, June 1, 2010 |
Phone | 416-392-8032 | |
Start Time |
1:00 PM |
boh@toronto.ca | ||
Location |
Committee Room 1, City Hall
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Chair | Councillor John Filion |
Members of the Board and Staff: Please keep this agenda and the accompanying material until the City Council meeting dealing with these matters has ended. The City Clerk’s Office will not provide additional copies.
Special Assistance for Members of the Public: City staff can arrange for special assistance with some advance notice. If you need special assistance, please call 416‑397-7767, TTY 416-338-0889 or e-mail boh@toronto.ca.
Closed Meeting Requirements: If the Board of Health wants to meet in closed session (privately), a member of the Board must make a motion to do so and give the reason why the Board has to meet privately. (City of Toronto Act, 2006)
Notice to people writing or making presentations to the Board of Health: The City of Toronto Act, 2006 and the City of Toronto Municipal Code authorize the City of Toronto to collect any personal information in your communication or presentation to City Council or its committees.
The City collects this information to enable it to make informed decisions on the relevant issue(s). If you are submitting letters, faxes, e-mails, presentations or other communications to the City, you should be aware that your name and the fact that you communicated with the City will become part of the public record and will appear on the City’s website. The City will also make your communication and any personal information in it – such as your postal address, telephone number or e-mail address – available to the public, unless you expressly request the City to remove it.
The City videotapes committee and community council meetings. If you make a presentation to a committee or community council, the City will be videotaping you and City staff may make the video tapes available to the public.
If you want to learn more about why and how the City collects your information, write to the City Clerk's Office, City Hall, 100 Queen Street West, Toronto ON M5H 2N2 or by calling 416-392-8032.
Declarations of Interest under the Municipal Conflict of Interest Act.
Confirmation of Minutes - May 3, 2010
Speakers/Presentations – A complete list will be distributed at the meeting.
Communications/Reports
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HL31.1 | ACTION |
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Ward: All |
Toronto Food Strategy: Cultivating Food Connections |
Origin |
(May 20, 2010) Report from Medical Officer of Health |
Recommendations |
The Medical Officer of Health recommends that:
1. The City Manager be requested to direct all City Divisions, and request Agencies, Boards and Commissions to identify and implement initiatives that support a healthy and sustainable food system, including those identified in Appendix 1 to the report (May 20, 2010) from the Medical Officer of Health “Cultivating Food Connections: Toward a Healthy and Sustainable Food System for Toronto”.
2. Immediate food strategy initiatives focus on leveraging existing resources and that any initiatives requiring new resources be dealt with through the 2011 City budget process.
3. The Medical Officer of Health report to the Board of Health and City Council in early 2011, including progress to date, proposed next steps and a recommended governance model.
4. This report be forwarded for information to the June 14, 2010, Executive Committee meeting.
5. This report be forwarded to key City Divisions as well as to Agriculture and Agri-Food Canada, Health Canada, Industry Canada, Environment Canada, Canadian Food Inspection Agency, the Public Health Agency of Canada; the provincial Ministries of Agriculture, Food and Rural Affairs, Children and Youth Services, Community and Social Services, Environment, Health and Long-Term Care, Health Promotion; the Ontario Public Health Association, the Canadian Public Health Association, Association of Local Public Health Agencies, the Ontario Agency of Health Protection and Promotion; the Dietitians of Canada, the United Way of Greater Toronto, Sustain Ontario, the Toronto Food Policy Council, Food Secure Canada Food, Consumer Products of Canada, Canadian Council of Grocery Distributors, Toronto Board of Trade, Canadian Restaurant and Foodservices Association; and the Directors of the Toronto school boards. |
Summary |
This report provides an update on the Toronto Food Strategy project, including the results of stakeholder consultation and engagement, and the actions proposed in the attached “Cultivating Food Connections: Toward a Healthy and Sustainable Food System for Toronto” report. Toronto Public Health (TPH) is spearheading the project to build a vision and inspire action toward a health-focused food system for the whole city.
The imperative for action to improve the food system is clear. Toronto faces a range of health, social and environmental problems related to food. Torontonians told us they are ready for a fresh take on food and want governments to champion creative and effective food solutions. Through a broad and inclusive consultation and engagement process, input was received from residents, community organizations, business, agriculture, City staff and other levels of government. The process employed facilitated discussions, workshops, an online discussion forum, digital storytelling and other innovative strategies to capture the voices of communities often underrepresented in consultations.
Some key themes emerged from the consultation process, especially the lack of access to quality food stores, the specific needs of newcomers adjusting to a new food system, and concerns about the lack of basic food skills and the unhealthy diets of children and youth. At the same time, many groups expressed interest in acting on community-based food solutions, including growing and cooking food (for consumption and sale) in their communities, purchasing food from local farmers, starting small food businesses and getting better access to neighbourhood food stores that sell fresh food.
The “Cultivating Food Connections” report urges Toronto to take the next steps to champion a healthy and sustainable food system. In doing so, the city stands to reap multiple benefits – healthier residents, more vibrant and livable neighbourhoods, stronger and more diverse economic development, better environmental protection, and a growing reputation as a leader in food system renewal.
The report recommends that the City Manager request all City Divisions, Agencies, Boards and Commissions, to identify and implement opportunities to embed food system initiatives in City policies and programs. It also provides numerous examples of actions that the City of Toronto can take, in active partnership with residents, community organizations and businesses, categorized according to the following six areas:
The actions are weighted toward those which can leverage existing resources and optimize the use of the City’s already-paid-for assets.
The Toronto Food Strategy project is an ongoing process. Toronto Public Health will initially coordinate the Food Strategy, including seeking new opportunities to leverage funding and provide support to City staff and the community to implement the actions identified in this report. The Medical Officer of Health will report periodically on progress to the Board of Health and will report to City Council in early 2011. |
Financial Impact |
There are no direct financial implications arising from this report. Costs for any food initiatives implemented in the short term will be covered through existing divisional budgets. Any initiatives requiring new resources will be considered through the 2011 City budget process. |
Background Information |
HL31.1-Toronto Food Strategy: Cultivating Food Connections - Staff Report (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30482.pdf) HL31.1-Toronto Food Strategy: Cultivating Food Connections - Appendix 1 (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30483.pdf) |
HL31.2 | ACTION |
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Ward: All |
2009-2010 pH1N1 Influenza Pandemic Summary Report |
Origin |
(May 17, 2010) Report from Medical Officer of Health |
Recommendations |
The Medical Officer of Health recommends that:
1. The Minister of Health and Long-Term Care:
a. update the Ontario Health Pandemic Influenza Plan (OHPIP) by specifying the pandemic roles and responsibilities of the Ontario Agency for Health Protection and Promotion (OAHPP), and the Local Health Integration Networks (LHINs);
b. designate LHINs as the lead agencies for the planning and implementation of flu assessment centres (FACs), including the identification of criteria for opening and closing FACs, in partnership with local public health units and primary care providers, including community health centres as key partners for ensuring that the needs of vulnerable populations are met;
c. mandate the province-wide use of real-time surveillance systems for timely monitoring of local influenza-like illness (ILI) activity;
d. ensure that the Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS) remains the coordinating agency responsible for processing and pre-approving community-based influenza vaccine orders for Toronto, during an influenza pandemic;
e. direct the Chief Medical Officer of Health to lead planning and coordination of communication with the primary care sector regarding pandemic influenza;
f. review the effectiveness of different methods of pandemic influenza vaccine delivery, as demonstrated in the pH1N1 pandemic, and include criteria for decision-making in the OHPIP.
2. The Medical Officer of Health report annually on the state of pandemic influenza preparedness, incorporating lessons learned from the pH1N1 pandemic.
3. The Board of Health request that the City Manager establish service agreements with community agencies with which Toronto Public Health partners in its role as the City emergency lead for psychosocial response, in consultation with the Medical Officer of Health.
4. The Board of Health forward this report to the Minister of Health and Long-Term Care, the Chief Medical Officer of Health, the Ministry of Education, the Ministry of Labour, the CEOs of the five Toronto-area Local Health Integration Networks (LHINs), the Association of Local Public Health Agencies (aLPHa), the Ontario Agency for Health Protection and Promotion (OAHPP), the Ontario Medical Association (OMA), the Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS), the Toronto District School Board (TDSB), the Toronto Catholic District School Board (TCDSB), and the City Manager. |
Summary |
In June, 2009, the World Health Organization (WHO) declared the first influenza pandemic of the 21st century, following the emergence and global spread of a novel strain of human influenza A (pandemic H1N1 influenza A, or pH1N1). This report describes the epidemiology of pH1N1 influenza in Toronto in 2009-2010, and outlines the major components of the Toronto Public Health (TPH) pH1N1 response:
- surveillance; - case investigation and management; - public information and risk communication; - immunization; - flu assessment centres; - stakeholder liaison; - occupational health and safety; and, - logistics and financial support.
Finally, the report reviews lessons learned from TPH’s evaluation of the pH1N1 response, and provides recommendations for strengthening pandemic and emergency preparedness and response in Toronto. |
Financial Impact | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
As detailed in Table 1 below, the total estimated extraordinary costs of the Toronto Public Health pH1N1 influenza outbreak response for 2009 and 2010 was $6,565.2 thousand. In 2009, the pH1N1 response incurred $6,072.5 thousand in expenses, and in 2010 an estimated $492.7 thousand. Extraordinary expenditures include overtime, security, and contracted nursing services costs. These expenditures exclude the base salaries and benefits of all Toronto Public Health staff assigned to the outbreak.
Table 1: TPH pH1N1 response cost and funding summary for mass immunization clinics
The Ontario Ministry of Health and Long Term Care (MOHLTC) provided the following funding:
- $10.00 per dose of pH1N1 influenza vaccine administered by Toronto Public Health, or $2,316.2 thousand for approximately 231,620 doses;
- $5.00 per dose of seasonal influenza vaccine administered by Toronto Public Health at mass immunization clinics in December 2009 and in catch-up pH1N1 and seasonal flu immunization clinics in January 2010, or $104.9 thousand for approximately 20,976 doses;
- 100 per cent of the cost to implement the Clinic Event Management System (CEMS), or $500.2 thousand; and
- 75 percent or $2,733.0 thousand of the remaining balance of $3,643.9 thousand with $2,532.8 thousand for 2009 and an estimated $200.1 thousand in 2010. The City of Toronto’s share totals $911.0 thousand for 2009 and 2010.
In addition, the Ministry of Health and Long-Term Care paid 75 percent of the base salaries and benefits of staff paid by the Ministry of Health Promotion and Ministry of Children and Youth Services totalling approximately $974.4 thousand.
The flu assessment centers (FACs) were funded through a separate process as reported to the Board of Health at its January 18, 2010 meeting. The Ministry of Health and Long-Term Care Emergency Operations Centre provided 100 per cent funding for the reimbursement of extraordinary costs to implement FACs, as part of the City's response to the second wave of pH1N1 in the fall of 2009.
There was no extra cost to the City over the approved budget for 2009. The estimated costs for 2010 of $492.7 thousand gross are expected to be within the per-dosage funding and Toronto Public Health's 2010 cost shared mandatory program funding. There will be no financial impact in 2010 beyond what has already been approved in Toronto Public Health’s 2010 Approved Operating Budgets.
The Deputy City Manager and Chief Financial Officer has reviewed this report and agrees with the financial impact information. |
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Background Information |
HL31.2-2009-2010 pH1N1 Influenza Pandemic Summary Report - Staff Report (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30493.pdf) |
HL31.3 | Information |
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Ward: All |
Influenza Immunization Rates of Healthcare Workers in Toronto Healthcare Facilities |
Origin |
(May 17, 2010) Report from Medical Officer of Health |
Summary |
Influenza is a highly contagious acute viral infection of the respiratory tract which causes annual seasonal outbreaks and periodic worldwide pandemics. Annual immunization of persons at high risk, and of health care workers (HCWs) and others who are capable of transmitting influenza to those at high risk, is the most effective measure for reducing the impact of influenza. Annual influenza immunization of HCWs is recommended by the National Advisory Committee on Immunization (NACI).
The 2009/2010 influenza season was “a different flu season” with a pandemic influenza strain, pandemic H1N1 or pH1N1, becoming the dominant circulating flu virus. The provincial influenza vaccination program was adapted in response to the pandemic. HCWs were identified as a priority group for pH1N1 vaccine as soon as the vaccine became available in late October 2009. Seasonal flu vaccine was offered to the general public, including HCWs, beginning December 2009.
In order for immunization programs to be successful, high rates of coverage are required. However, influenza immunization coverage among HCWs in Toronto and Ontario remains low despite direct efforts to increase the rates before and during the pH1N1 pandemic.
During the 2009/2010 influenza season, the median coverage rate for pH1N1 influenza immunization among HCWs working in institutional settings in Toronto was 58% for acute care facilities (ACFs), 59% for Complex Continuing Care (CCC) hospitals, and 39% for Long-Term Care Homes (LTCHs) (Tables 1a, 1b and 1c). The rates for ACFs and CCC hospitals are comparable to those reported for seasonal flu vaccine in the previous two seasons (2007/2008 and 2008/2009) in Toronto; the rate for LTCHs was lower.
The median coverage rate for seasonal influenza immunization among HCWs working in institutional settings in Toronto was 17% for ACFs, 21% for CCC hospitals, and 42% for LTCHs (Tables 1a through 1c). These rates are lower than those reported for the previous two seasons (2007/2008 and 2008/2009), and much lower than the annual influenza immunization coverage rate target of 70% recommended by the Ontario Ministry of Health and Long Term Care (MOHLTC).
This report provides pH1N1 and seasonal influenza immunization coverage rates for HCWs in Toronto hospitals (acute and complex continuing care) and long-term care homes in 2009/2010. |
Financial Impact |
There are no financial implications arising from this report. |
Background Information |
HL31.3-Influenza Immunization Rates of Healthcare Workers in Toronto Healthcare Facilities - Staff Report (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30484.pdf) |
HL31.4 | Information |
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Results of Follow-up of Previous Audit Recommendations |
Origin |
(May 10, 2010) Report from Auditor General |
Summary |
The Auditor General’s Office conducts an annual follow-up review to determine the extent to which audit recommendations have been implemented. Recommendations contained in audit reports issued since January 1, 1999 by the Auditor General are included in the annual follow-up process.
The purpose of this report is to inform the Board of Health of our current year follow-up results pertaining to audit recommendations in reports previously issued to the Board.
In our 2009 annual follow-up review, two recommendations from the report entitled “Review of City of Toronto Pandemic Planning and Preparedness” were determined to be not fully implemented. These two recommendations were carried forward to the 2010 follow-up review.
In our current review, we verified that appropriate actions have been taken by staff to implement the two outstanding recommendations, and as such they have been assessed as fully implemented.
Audit recommendations fully implemented since our last follow-up review are listed in Attachment 1.
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Background Information |
HL31.4-Results of Follow-up of Previous Audit Recommendations - Staff Report (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30485.pdf) |
HL31.5 | ACTION |
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Ward: All |
Sole Source Contract for the Provision of Proprietary Software Purchases, Professional Services, and Software Maintenance from CSDC Systems Incorporated |
Origin |
(May 14, 2010) Report from Medical Officer of Health and the Director, Purchasing and Materials Management |
Recommendations |
The Medical Officer of Health, and the Director, Purchasing and Materials Management, recommend that:
1. City Council grant authority to the Medical Officer of Health to enter into a sole source contract with CSDC Systems Incorporated for the purchase of CSDC AMANDA software, professional services and software maintenance at a cost not to exceed a total of $951,708 net of HST recoveries over five years (2010-2014).
2. City Council grant authority to the Medical Officer of Health to execute a five year agreement in accordance with the report (May 14, 2010) from the Medical Officer of Health and the Director, Purchasing and Materials Management, and in a form satisfactory to the City Solicitor.
3. This report be forwarded to the Government Management Committee meeting on June 17, 2010 for consideration. |
Summary |
This report seeks City Council approval for the Medical Officer of Health (MOH) to award a sole source contract to CSDC Systems Inc. to purchase additional software modules for the existing AMANDA software, professional services to implement the software and software maintenance for the period of five years from 2010-2014 for an estimated value of $951,708 net of HST recoveries.
The software and corresponding services are proprietary to CSDC Systems Inc. and match the existing Toronto Public Health (TPH) infrastructure. Products provided by CSDC Systems Inc. were implemented by TPH in 2002. Subsequently through the intervening years the City has issued sole source contracts to CSDC Systems Inc.
CSDC AMANDA software has been used by TPH to develop and sustain the Toronto Healthy Environment Information System (THEIS) and the Infection Control Information System (ICIS). THEIS and ICIS support the TPH Healthy Environment program and the Communicable Disease Control program in managing, scheduling and executing health inspections, investigations and risk assessments associated with the enforcement of Provincial Acts, Municipal Codes and Regulations pertaining to food safety, health hazards, rabies, water safety, tobacco, senior homes and personal service establishments such as tattoo parlours. THEIS also supports full public disclosure of food safety inspection results via the DineSafe Website. |
Financial Impact | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
The total sole source contract award identified in this report is $951,708 net of HST recoveries.
A portion of the contract award, $357,999 gross and $89,500 net of provincial cost sharing (net of HST recoveries) for software maintenance, will be funded from the future years’ Operating Budgets for Toronto Public Health, and $593,710 net of HST recoveries for new software and professional services, is funded from the Toronto Public Health 2010 Capital Budget and the 2011 to 2019 Capital Plan.
The funding for the proprietary software and associated professional services and software maintenance for the period 2010 to 2012 in the amount of $593,710 net of HST recoveries is available in the Toronto Public Health 2010 Capital Budget and the 2011 to 2019 Capital Plan in WBS CPH001-09 (Healthy Environment Inspection System), Cost Element #’s 3420, 4038, 4474.
The funding for the provision of software maintenance for the period 2011 to 2014 in the amount of $357,999 gross and $89,500 net (net of HST recoveries), will be included in the 2011 to 2014 operating budget submissions for Toronto Public Health. Software maintenance is funded from cost element # 4474 within the 2010 Approved Operating Budget for Toronto Public Health as an ongoing Program expense. Funding requirements for 2011- 2014 will be included in the respective year’s operating budget submission for Toronto Public Health and will be accommodated within approved operating budget targets.
The table below provides contract spending estimates for each year.
The Deputy City Manager and Chief Financial Officer has reviewed and agrees with the financial impact statement. |
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Background Information |
HL31.5-Sole Source Contract for the Provision of Proprietary Software Purchases, Professional Services, and Software Maintenance from CSDC Systems Incorporated - Staff Report (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30486.pdf) |
HL31.6 | ACTION |
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Phase-out of Coal Fired Electricity |
Origin |
(March 24, 2010) Letter from Jack Gibbons, Chair, Ontario Clean Air Alliance |
Summary |
The Chair of the Ontario Clean Air Alliance requesting an opportunity to appear before the Board of Health to request support of a resolution requesting the Government of Ontario to direct Ontario Power Generation to put its coal plants on standby reserve immediately and only operate them if they are absolutely needed to keep the lights on in Ontario. |
Background Information |
HL31.6-Phase-out of Coal Fired Electricity - Letter from Jack Gibbons, Chair, Ontario Clean Air Alliance |
HL31.7 | ACTION |
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Special Diet Allowance |
Origin |
(May 10, 2010) Letter from Members of the Street Nurses Network |
Summary |
Members of the Street Nurses Network requesting an opportunity to appear before the Board of Health requesting that the Board of Health support the reinstatement of the Special Diet Allowance. |
Background Information |
HL31.7-Special Diet Allowance - Letter from Members of Street Nurses Network (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30488.pdf) |
7a | Special Diet Allowance (SDA) Program |
Origin |
(May 10, 2010) Letter from Councillor John Filion, Chair, Toronto Board of Health, to the Minister of Community and Social Services |
Summary |
Councillor John Filion, Chair, Board of Health, forwarding a copy of his communication to the Minister of Community and Social Services advising that the Board of Health on March 22, 2010, requested the Chair of the Board of Health to write to the Minister of Community and Social Services requesting the Minister to:
a. continue the Special Diet Allowance (SDA) Program as part of Ontario’s social assistance system; and
b. implement the Ontario Human Rights Tribunal’s decision to provide adequate financial support to those eligible.
The Chair of the Board of Health raised serious concerns about the decision to discontinue the special diet allowance; emphasized the need to continue to provide the special diet allowance to those who have special medical conditions such as multiple sclerosis, diabetes and heart disease with assistance to enable them to pay for diets generally recognized by the medical community as necessary to deal with their conditions; and supported the call for open and transparent consultations with poverty groups and health care stakeholders to ensure that the new program does not further endanger the health of the most vulnerable members of our community. |
Background Information |
HL31.7a-Special Diet Allowance - Letter from Chair of the Board of Health to the Minister of Community and Social Services (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30489.pdf) |
HL31.8 | Information |
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Local Health Committee Minutes |
Summary |
Local Health Committees submitting the following:
- Minutes of the Etobicoke/York Local Health Committee meeting held on February 11, 2010; and
- Minutes of the Scarborough Local Health Committee meeting held on March 15, 2010. |
Background Information |
HL31.8-Etobicoke/York Local Health Committee Minutes - February 11, 2010 (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30491.pdf) HL31.8-Scarborough Local Health Committee Minutes - March15, 2010 (http://www.toronto.ca/legdocs/mmis/2010/hl/bgrd/backgroundfile-30492.pdf) |