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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

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.

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:

• Support food friendly neighbourhoods
• Make food a centerpiece of Toronto’s new green economy
• Eliminate hunger in Toronto
• Connect city and countryside through food
• Empower residents with food skills and information
• Urge federal and provincial governments to establish health-focused food policies

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.

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.

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.

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.

There are no financial implications arising from this report.

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.

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.

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.

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.

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.

 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.