The Decision Document is for preliminary reference purposes only.  Please refer to the Committee’s Report to City Council or to the Minutes for the official record.

The Board of Health:

1.         requested the City Manager 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.         directed that 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.         directed the Medical Officer of Health to 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.         directed the Medical Officer of Health to explore with the Toronto Foundation for Student Success and the Toronto District School Board the re-establishment of basic food skills, including preparation, as part of the curriculum in Toronto’s schools;

5.         directed the Medical Officer of Health, as part of the food preparation mapping strategy, to also report on the number of classroom kitchens that have been eliminated from Toronto schools since amalgamation;

6.         requested the Ontario Public Health Association and the Association of Local Public Health Agencies to advocate for the Ontario curriculum to require food preparation courses;

7.         directed the Medical Officer of Health to ensure that the new City Council members are made aware of the importance of food security for the city and the Toronto Food Strategy;

8.         forwarded the report (May 20, 2010) from the Medical Officer of Health to the June 14, 2010, Executive Committee meeting for information; and

9.         forwarded the report (May 20, 2010) from the Medical Officer of Health 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, Education; the Ontario Public Health Association, the Canadian Public Health Association, the Association of Local Public Health Agencies, the Ontario Agency for Health Protection and Promotion; the Dietitians of Canada, the United Way of Greater Toronto, Sustain Ontario, the Toronto Food Policy Council, Food Secure Canada, Consumer Products of Canada, Canadian Council of Grocery Distributors, Toronto Board of Trade, Canadian Restaurant and Foodservices Association; the Directors of the Toronto school boards; and the Local Health Integration Networks.

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.

The Board of Health requested 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 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.         This report be forwarded 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.

The Board of Health:

1.          received, for information, the report (May 17, 2010) from the Medical Officer of Health; and

2.          referred the following motion to the Medical Officer of Health for consultation with the stakeholders in the health care sector, particularly the long-term health care sector, including the unions in the sector:

Motion by Councillor Filion:

“That the Board of Health:

1.         request the Ontario Minister of Health and Long-Term Care to take proactive measures to increase influenza immunization coverage rates for healthcare institutions; and

2.          if coverage rates do not improve significantly, the Minister consider other measures, including mandatory immunization, for some categories of health care workers.”

The Board of Health received Item HL31.4 for information.

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 Board of Health recommended to the Government Management Committee 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.

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 Board of Health:

1.         requested the Minister of Health and Long-Term Care to ensure that the new Nutritional Supplement Program will enable all people on social assistance who have specific medical conditions requiring special diets to have the means to pay for those diets; and

2.         referred Item HL31.7 to the Medical Officer of Health for a report to the Board of Health on June 28, 2010.

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.

The Board of Health recommends that:

1.         City Council authorize the City Manager to negotiate and enter into Mutual Aid Agreements with Boards of Health as appropriate.

2.         City Council instruct the City Solicitor and the Chief Financial Officer and Treasurer to prepare and review each Mutual Aid Agreement as required.

3.         City Council direct the Medical Officer of Health in collaboration with the Office of Emergency Management to implement and maintain these agreements on an ongoing basis and provide timely information reports to City Council subsequent to the activation of any mutual aid agreement.

The Board of Health referred Item HL31.10 to the Medical Officer of Health with the request that he comment as part of the Transit Project Assessment Process on the requirement for mitigation measures to protect human health and well being, and to suggest measures or alternatives that would realize the best possible transit impact for the City and least impact on the surrounding neighbourhood, and forward his findings to the Board of Health.

Councillor Paula Fletcher asked the Board of Health to request the Medical Officer of Health to comment as part of the Transit Project Assessment Project on the requirement for mitigation measures to protect human health and well being and to suggest measures or alternatives that would realize the best possible transit impact for the city and least impact on the surrounding neighbourhood and forward his findings to the Board of Health.