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Board of Health – January 13, 2020

Good morning, everyone. So we have quorum
and I will call this first meeting of the Board of Health for 2020 to order. So welcome
to members of the board, to the other members of council in attendance today and to members
of the public. You can follow the agenda and debate on your computer, smart phone. The
Board of Health acknowledges the land — we also acknowledge that Toronto is covered by
Treaty 13 with the Mississaugas of the — are there any declarations of interest? Being
none the first item of business is election of chair for 2020, Board of Health.
We will now consider the item. Are there any nominations for chair of the
Board of Health? I guess Councillor Wong-Tam. Yes, thank you very much, I’d like to nominate
Councillor Cressy for position of chair Board of Health.
So director Wong-Tam — director Cressy, do you accept the nomination?
I’m calling nominations a second time, are there any further nominations? I’m calling
nominations a third and final time, are there any further nominations? As there are no further
nominations the nominations are now closed. Director Cressy is the only nominee. Soy declare
director Cressy elected as chair of the Board of Health for a term of office starting January
13th, 2020, and ending December 31st, 2020 and until a successor is appointed. I will
now ask director Cressy to assume the chair in order to conduct the election for vice
chair. Well, thank you kindly and thank you to director
Wong-Tam for that. We will now proceed with a run through of the agenda. We’ll go through
the whole orange sheets before dealing with each item. So on the orange sheets as we go
through item 13.2 election of a vice chair for 2020, Board of Health, that will be held
down as we have to deal with it. Item hl 13.3, promoting and ensuring accountability
at Toronto Public Health. We have speakers on that. That will be held. Item hl 13.4,
2019-year in review of Toronto Public Health, would anybody like to hold that down? Ministry of Health’s consultation
on changes to public health in Ontario, I would like to — there’s a presentation. So
that will be held down. Item hl13.7, mobile dental clinic 3-month pilot on alternate service
delivery model. I had like to hold that down. Item hl 13.8 subway health impact study. There
are speakers and I believe there is one new business item that needs to be added to the
agenda. It comes from director Layton concerning gambling. Do we need a motion to add that to the agenda?
There are 2 speakers, our first speaker is Derrick, Derrick, you know the drill.
There’s a clock on my right. You’ll have five minutes. And you can begin
when you’re ready. I just want to point out that clapping is
allowed here after all. I just want to say by me speaking at this meeting that shall
not be deemed [indiscernible] and long live her majesty the queen.
[indiscernible]. Section 8 of the constitution act 1982, as never given the City of Toronto
expressed statutory authority to do this. Now, I guess kind of expecting the auditor
general would actually be here for this item. So I guess I’ll just go on. So in this report
it says Toronto Public Health has been selected along with other public health units to participate
in 3 significant value for money audits. Food safety inspection program audit, immunization
audit. Now, something that the oughted dealt or general said at Audit Committee before
that I never thought I’d hear someone at the City of Toronto say and I made a meme out
of it. You can see there she said my first statement is always be clear on the law. So
I just want to refresh your memory that as part of — she’s also a lawyer. As part of
the oath she took to the law society amongst other things it says I shall not pre severe
the law, I don’t think she will, just the City of Toronto — I shall seek to improve
the administration of justice. I just want to point out justice is defined agency the
fair and proper administration of laws because in regards to the immunization school act
there’s something about acts in the statutes this place probably isn’t aware of.
Can I just ask you to keep your items to the items we’re dealing with, we’re dealing with
the audit item? Can I get you to respect my freedom of expression.
Derek — this place is taking Premier Ford to court on the basis that he violated freedom
of expression and because of it you’re not able to provide effective presentation. You’re
interpreting me, okay. Okay. Could you just keep your remarks to
the item — [Multiple Speakers]. The item in the report talks about the immunization
act. Speaking on something in the report, — federal
court paper which is written by chief justice of the Court of Appeal for Ontario gorge — says
Canadian maritime law is that body of law defined in section 2 of the federal court
act. That law was the maritime law of England as it has been incorporated in the Canadian
law and it is not the law of any province of Canada, okay. We got that. So here’s what
it says in ag versus [indiscernible] wire and nail 1979 Supreme Court of Canada.
Canadian maritime law means the law that was administered by the court of Canada on — [indiscernible]
act or any other statute. I think we’d all agree that ispa is a statute, right?
Or that so administered if the court — unlimited jurisdiction — the reference to the act is
undoubtedly to the act of 1934 but the act of 1891 although it was repealed may certainly
be considered as any other statute. By virtue of which the law was administered on — immunization
school people’s act any other statute. So what exactly is the law?
Well, I wrote — I got a response back from my normaler npp’s office about this. Hello,
Derek I’ve been in touch with the attorney general’s office with regards to your question.
The answer that Ontario does not have a civil code, we have rules of civil procedure but
deal with procedural matters only. Ontario is a common law jurisdiction and we
rely on the common law not a code. Please feel free to contact us if you have more questions
in the future. If you guys are interested my MPP at the time it says there was Mike
Colle. So he knows what the law is. So I just want to point out ispa maritime law the law
of the water that applies to crew members on somebody else’s vessel in reality we live
in a common law jurisdiction where the rules of equity apply also that’s section 96.1 of
the courts of justice act where we live on dry land. Do you see how the two do not jive?
You can not force maritime rules upon us when we’re not crew members on your vessel. So
— versus dome 1996 Ontario Court of Appeals said the charter applies directly to government
acts in section 32.1 and any government action is of no force and effect to the extent that
it is inconsistent with the constitution act 1982 section 52.
Thank you. [Multiple Speakers].
You interrupted me, okay I’m just going to finish up this one.
One last sentence. Thank you. I need two. A legislative enactment which
is unconstitutional is akin to a judicial order made without jurisdiction both are made
without authority just as an accused can challenge the jurisdiction of the court.
This is from the Board of Health background quote
paragraph 1, in accordance with the ministry’s published standards, protocols and guidelines,
using provincial funding which comes from the taxpayer. Then item 7 public health modernization
page 1, second paragraph, we clearly heard and responded to the need for more. Extensive
consultations across the province on how best to move forward. page 2
first paragraph the rise and unprecedented emergencies such as Oh
points clearly Ministry of Health has not moved
forward on the overdose protocol which increases morbidity and mortality anyone
Gary age of raspberry with assist Gary that’s item number seven so if you’d
like to defeat this item we’re dealing with is the audit process if you could
keep your remarks to the item in front of us please I’m worried about the
taxpayer spending a needless untold millions of dollars so many left with
permanent brain damage oxygen deprivation
you’ve taught millions of people it all started here September 2011 and it’s
been going across the country ever since thought millions of people all the
science of respiratory emergency deny rescue breathing give chest compressions
still feeding heart and they’re doing it so I’m just wondering about
accountability who’s accountable is anybody going to be held accountable here’s
a letter from the executive director at Health Canada explaining that the
different provinces have different protocols why is that human kindness no
though a court should apply genesis 2:7 and God breathed the breath of life into
humankind John 20:22 and Jesus breathed upon his disciples when you crucify
someone they suffocate to death Gary could I ask you we’re dealing with an
item on audits so if you could keep your comments to the item related to the
audit process please yeah I’m wondering why you haven’t been audited all the
money okay that the taxpayer is losing needlessly thank you why even do audit
yourself aren’t you concerned for your own lives
yeah I suffer an injury or illness they put you comatose and people are eagerly
going to start pounding on your chest not worried ain’t worried about being sued
maybe there was a coroner’s inquest dr. Elaine Davila was there jury’s verdict
was do not deny risky breathing from anyone thank you very much are there any
questions for Gary seeing none thank you very much Gary there any other speakers
to this item okay seeing none we have a report in front of us would somebody
like to move the recommendation in the report to receive it moved by director
Wong-Tam all those in favour opposed if any
that carries just before we go on to item HL 13.5 we do have to confirm the
minutes from our meeting of 2009 2019 director perks move the confirmation of
the minutes all those in favour opposed if any
that carries thank you so we dealt with item 13.4 already so item 13.5 housing
approaches that support health we have a public speaker on this Derek you’re
registered to speak Derek you’ll have five minutes I just
want to point out this is part of an affidavit that was admitted into the
record by Justice Kavanaugh Wendy on Renee took the police board to court
this is a City of Toronto lawyer telling Dan Councillor Mammal Edie that basically
when people come to speaker they can talk about whatever they want I just
want to acknowledge Councillor Carol for eluding as something I said it’s special
governance recently that nowhere in Toronto City Council procedures is there
a rule that says people who go to speak at City of Toronto public meetings can’t
ask questions of their public servants so in this report it says
recommendations reinforce the need for federal and provincial funding to allow
City of Toronto to act on its commitment to increase housing options for
Torontonians in particular housing for vulnerable populations now I’m just
about to read a bunch of case law on housing so I mean if you guys want to
check your phones or computers I won’t you know I won’t know any different mass
versus Ontario Ministry of Community and Social Services 1996 Ontario Superior
Court divisional court said that whatever the outer limits of the concept
of security the person may be it must at least involve having adequate food and
shelter for physical survival although the question of economic rights
fundamental to survival is an open one in the Supreme Court of Canada it has
been considered by courts below that level in a number of the above decisions
denying violation of section 7 the courts of approved statements made by
Professor Peter Hogg in his constitutional law of Canada they’re
Professor Hogg considered the argument that security of the person in section 7
included the economic capacity to satisfy basic human needs like housing
he considered the possible rule the courts in dealing with such an argument
lagravis versus Pitt 2008 Ontario Superior Court in Yin versus Lewin
justice rook also said again referring to Hogg as Authority
moreover the right to security of the person under Section 7 does not include
Economic Security except perhaps to the extent of economic capacity to satisfy
basic human needs again like housing Singh versus minister of employment and
immigration 1985 Supreme Court of Canada like Liberty the phrase security of the
person is capable of a broad range of meaning the phrase security the person
is found in section 1a the Canadian Bill of Rights and his interpretation in that
context might have assisted us in its proper interpretation under the Charter
unfortunately no clear meaning of the words emerges from the case law although
the Frasers sees some mentioned in such cases as Morgentaler versus the queen
ker versus the queen and our versus Barry the Law Reform Commission in its
working paper number 26 medical treatment and criminal law 1980
suggested at paragraph 6 that the rights of security the person means not only
protection of one’s physical integrity but the provision
of necessaries for its support the Commission went on and described the
provisions of necessaries in terms of article 25 paragraph 1 of the Universal
Declaration of Human Rights which reads everyone has the right to a standard of
living adequate for the health and well-being of himself and of his family
including food clothing housing if housings are right like where do we ever
get it into our heads that we had to pay for it if it’s a right we shouldn’t have
to pay for it to begin with and medical care and necessary social services and
the right to security and the event of unemployment sickness disability
widowhood old age or other lack of livelihood and circumstances beyond his
control commentators have advocated the adoption of a similarly broad conception
of security the person in interpretation of section 7 of the Charter reference
regarding sections 193 and 195 point 1 1 C of the Criminal Code. Manitoba 1990 needs Supreme Court of Canada
in order to give section 7 that interpretation security of the person must be interpreted
to mean the economic capacity to satisfy basic human needs like housing. That is to earn
a living. Nowhere in section 7 is there reference of property rights and that omission in my
opinion is significant. It should be noted that the court expressly stated that it was
not deciding that section 7 could not comply to any interest which has a commercial property
component. Another case [indiscernible] 1988, BC Court of Appeal also deadly generally with
the economy of economic interests and section 7 of the charter. Claims are not within the
purview of section 7 of the charter although she did add the caution that she was not asserting
that section 7 could never include an interest with an economic component. The problem with
that is that if you ask your politicians your so-called trustees how to use the security
of the person to pay for cost of housing they won’t tell anybody which — there’s concealing
information — thank you. [Multiple Speakers].
Five minutes thank you. Concealing information — are there any questions
for the speaker? Seeing none thank you very much.
I didn’t know this place was so much fun. Thank you.
All right. Are there any other speakers on this item?
Okay. So now we’re going to move this into committee.
Questions of staff? I see we have staff here from shelter supporting housing administration
as well. Does the City of Toronto happen to target for how many new units of supporting
housing to building. Yes, through the chair we do, that number
is 18,000 over 10 years. And is that because there is a waiting list?
There is a waiting lift for social housing, yes.
Do we know what that waiting list is? The wait list for supportive housing is growing
to 8,000 plus people at this time. Okay. So the City of Toronto has a target
to build 18,000 units which — I see is referenced in the housing to action plan we’re dealing
with here. Is there a plan for the City of Toronto to build supporting housing units
or a target to build. So through the chair, we are going to be reporting
back with our colleagues to the housing secretary to the housing and planning committee in February,
February the 12thth, and within that report, we’ll have more specifics regarding a target
of 600 units of supportive housing to be built this year.
So 600 units each year for the City of Toronto to create 600 units, your reporting — there’s
a report coming to plan and housing in February on that.
That’s right. Okay. Those are all my questions.
Yes, director mulligan. I have a question for the medical officer
of health, can you clarify the role of Toronto Public Health in providing services in public
housing or funding services related to public housing?
So through the chair, thank you for the question. So again, we’re a population health service,
right, and we work in public health. So our areas tend to be more around first and foremost
population health assessment and actually talking about and appreciating and understanding
the health impacts of under-housing and homelessness in respect of our population. So I would say
first and foremost that’s where we are involved in what I would characterize the diagnosis.
We also work quite actively with our Shelter Support and Housing colleagues particularly
around infection prevention and control aspects. Within the context of congregate settings.
And we have a long and established history working with our partners there. We do have
some other teams communicate — with community development officers that do some very specific
work with particular populations, but much of the service that’s provided is through
our colleagues at SSHA and through community agencies as well, but that gives you a bit
of a high level overview. Any other questions?
Director Layton. Thank you very much. So our goal is 18,000
over the next ten years, how many of these supportive housing units have been funded
by the federal provincial government in the last 10 years?
So through the chair, I don’t have a number for you over the last 10 years. I can say
of the target that has been established there’s no you know, concrete funding on the table
at this point other than the national housing strategy that the federal government would
have in play. So we don’t currently have any funding on
the table for the last — or for the target that’s set — any idea how many we built were
opened last year of supportive housing units? I don’t have that for you right at the top
of my fingers here but I could report back. Was it anywhere close to 1,800?
No. Okay. Thank you.
Okay. Thank you. Director Wong-Tam. Yes, following up on director mulligan’s question
regarding public health responsibility, if it is not the responsibility of public health
to provide onsite supports to the tenant population who needs supportive — the additional wrap
around supports, who’s responsibility is it and what order of government should be funding
it? So through the chair, when we talk about supportive
housing and we’re talking about health care supports in particular, that will fall under
the purview of the ministry, so a number of those supports are indeed health care related,
let me be very clear by that, hence, I would say the provincial government being the appropriate
partner with whom to follow-up. And so that will include mental health services
in sort of social housing? Through the chair, when we talk about mental
health services, often we are talking about mental health care and treatment and related
resources in respect of mental illness, so, yes, it is within the purview of the provincial
government. Most notably I would say the Ministry of Health.
And because the Ministry of Health themselves don’t deliver the service on the front lines
they would be funding organizations that are community-based mental health oriented, they
would be funding the Ontario mental health hospital such as — what’s their responsibility
when the money comes from the Ministry of Health provincially which organization should
be in the physical buildings providing contact direct service to those social tenants?
So through the chair, there are a number of different agencies that provide those services.
So and we are actually in a — what I would characterize as a bit of a period of transformation
and flux within health care. So what happens is that we have very briefly the Ministry
of Health who in turn until recently has funded the networks who are in turn responsible for
flowing fund to community agencies. That system is in flux for lack of a better term.
We used to have 14 local health integration networks we’re now down to, I believe it’s
5 regional offices all run under Ontario health but suffice it to say that the funding for
community agencies that deliver those kinds of health care services in the community does
come at least in part through the Ministry of Health. I imagine that some of them get
some funding through other ministries or other routes as well. But I would also point out
that there is home care that has traditionally been run through the ccacs which were community
care agencies that have traditionally been under the purview of those local health integration
networks, and again, that’s all rather very much in transformation and flux right now,
but that’s where the funding has gone through. And for tenants who are in sole housing that
require supports around addiction and treatments and substance use, who’s responsibility would
that be? So through the chair, that is also the health
care system, and I would suggest to you that based on my knowledge, there’s actually not
very much that happens within the context of housing. There is a health care system
that actually requires that people go to health care facilities to make available those [inaudible].
And finally because recommendation 2 says that we should be urging the federal and provincial
governments to increase funding to community-based organization health care providers and so
forth, what’s the role of the federal government so far?
Because you’ve highlighted a lot of what the province is supposed to do, what’s the federal
government supposed to do? Through the chair, I think the federal government
has a number of different roles to play here. Certainly with respect to the national housing
strategy and outlining of framework in which these services can be — so you have housing
and services considered as part and parcel. I think when it comes to issues around managing
substance use and challenges related to substance use the federal government certainly has some
purview over legislation that has to do with the controlled drugs and substances act. And
I think there are certain provisions that they can make that facilitate the ability
of service providers to provide service. Thank you very much.
Thank you. Are there to speak? All right I’m going to put myself on the list. And if I
could move an amendment which is can be placed on the screen to request the medical officer
of health in consultation with the deputy city manager and gm of our Shelter Support
and Housing division and the housing secretary to report to the April meeting with details
of the city’s new plan to create 600 supportive housing units every year. So let me just walk
through that a bit. As the report spoke to on every wrung of the housing ladder, people
are stuck. So for the 8,000 people within our homeless population if they have access
to a shelter they’re often stuck without being able to exit the shelter. For the 15,000 people
on the waiting list for supportive housing there aren’t units to get to. For the 181,000
people on the waiting list for subsidized affordable housing that listen is getting
longer not shorter. And so housing at large effects the health of Torontonians and I’m
grateful that our medical officer of health is continuing to bring forward reports on
this matter. Supportive housing is one critical piece. And it’s a critical piece where I think
Toronto Public Health has a key role to play both in terms of advice to give and perhaps
involvement in it. And so 2 years ago the City of Toronto set a target we’re going to
build 1,800 supportive housing units a year for 10 years, we have not been meeting that
target but we set a target. 2 months ago City Council directed city staff
to come up with a plan to create 600 units, 1-3rd of those 1,800 per year for the city
what plan — every year starting 2020. That plan will be coming to the planning and housing
committee here at the city in February. I think it’s important that this board considers
that plan. And considers any role we might play and advice we might provide or recommendations
as well. And so that’s the — in April we’ll be looking at the new plan to create these
units on an annual basis and I hope it’s a great plan but I’m looking forward to the
medical officer of health giving us advice. Those are all my comments. Are there any other
speakers, okay, question or speaking? Speaking.
Yes, okay. Yeah, I want to speak in support of this motion
and to suggest that part of the role of assessment could be for Toronto Public Health to include
health assessment as the City of Toronto takes on building of supportive and affordable housing
that assessment of health impacts and health estimation, costs and savings should be an
important consideration. Thank you. Any other speakers? Okay. Seeing
none, could we take this — it was to receive as a report. So we just moved the amendment
is that correct, all right the amendment is on the screen and adopt as amended, all those
in favour? I was just in conversation with the medical
officer of health. I think because there’s a report that deals with this matter going
to planning and housing, what I’d like to do is take the staff report that’s going to
be generated from I believe — [inaudible] housing secretary directed to the medical
officer of health so that she can perhaps put the health lens over that report and bring
it back to this committee as opposed to writing a separate report. Just to set up some expectations.
So you’ll still get the — you’ll still get the outcome, you’ll still have a chance to
deliberate this item here especially with medical officer of health’s comments over
the housing report. I think that is the intention, it’s not to
create a whole new plan. It is to bring forward that report. To the April meeting with the
medical officer of health’s advice on it. Very good. So just to clarify, so it’s not
to necessarily write a whole new report? Correct.
Thank you. Okay.
Okay. Are you satisfied, that is the intent in f
your satisfied. Yes.
Okay. So then the amendment we’ll take it as a package amendments and the motion as
amended, all those in favour? Opposed if any? That carries.
Thank you. Okay that takes us onto item hl13.6. Everybody’s favourite topic Ministry of Health’s
consultation on changes to public health in Ontario.
And we have a staff presentation on this. And so, gayle, I will turn it over to you
whenever you’re ready. Great. Thank you. Good morning. This is a
presentation on public health. In November of 2019 the Ministry of Health announced a
consultation with stakeholders — at the same time the ministry released a report called
public health modernization. This presentation is to update you and provide information for
consideration in a response. The consultation process kicked off in November
and lasts until approximately February of year.
It consists of 2 parts first an in person meeting that’s being held across the province
with various health units, boards and their senior staff. Our meeting is scheduled for
February 10th. The other part of the consultation is a survey,
it’s online 21 questions it is open until February 10th. To gather information for the
survey we held an all day workshop in December to which all management and front line staff
were invited. We’ve taken the information and summarized it along with internal staff
survey that includes all 21 questions that our staff can give input to and then we can
summarize for our response. Because the survey is opened we’ve encouraged or staff to respond
as teams, to respond through professional associations and respond as individuals.
Essentially that’s the consultation as we know it now.
Public meetings ours being February 10th and there’s an online survey. To respond to the
survey it’s useful to look at previous reports. There are many. . I’ve listed a few here.
They came after major events. The titles are revealing they all speak to
some form of revitalization or renewal and they all have a call to action to strengthen
public health. A review of these reports shows that the recommendations boil down into 2
main areas, the first is public health as a system not as a narrow delivery agent of
a small number of programs but a system onto itself. The second set of recommendations
all speak to principles that will strengthen public health as a system. So the next few
slides I’ll go through how these reports written by public leaders over the years characterize
public health as a system. It’s helpful to look in comparison to the health care system
which — [indiscernible] was speaking to earlier and understand how we distinct and different
but how individuals do flow between those 2 systems. So for example an individual in
the community may have contracted tuberculosis and been picked up our surveillance function
and then move into care in an institution. So we would then be working with the individuals
in the institution to transfer that individual and they may come back out into the community
and be monitored by our staff when they leave a health care institution with a condition
such as tuberculosis and need to be monitored in the community.
But when you look at the list of functions on the left-hand side there the movement of
individuals with a health care issue really pertains to health protection, mostly the
disease programming, some dental and some other programs but when we’re dealing with
individuals we’re dealing with bullet 5 health protection but there are many other functions
listed there that we do and always concerned not with just individuals but whole populations,
sub populations such as schools and concerned with them throughout their entire lifetime
and do many different functions and interventions rather than narrow function that health care
as a system provides. That’s the first message that the leaders in public health brought
forward in these reports and that is that we have a broad range of functions that we
need to provide as a system. The second major theme that they brought forward was that we
work with a broad range of organizations by work with I mean in a formal sense. We can’t
do our work unless we are in a form relationship and moving information or understanding context
with particular organizations. I mention this because the survey asks quite specifically
how we can work for closely with health care or social services. The authors of these reports
that I reviewed would say we are open to working more closely with health care and social service
but we also need to continue to find ways to work even more closely with the organizations
and departments that are listed here. So clearly you’ve seen through the years many reports
that have come forward based on our work with Municipal Licensing and Standards, planning
an transportation to build healthy communities. We’re currently working with — on vaping
and tobacco bylaw work and we consider that to be very important work that has to be done
in close partnership with those particular departments but also community organizes that
have listed there who sometimes are the third party deliverers of our program. So sometimes
we’re funding community organizations to provide nicotine replacement therapy or spoking cessation
in high risk communities. We also are legislated to work with organizations such as day care.
The second big theme there’s a wide variety of organizations we need to work with. The
next theme that comes out from these reports it’s helpful to understand how our particular
interventions are different than the health care system where again the focus is an individual
who brings themselves in need of care is a assessed, diagnosed treated or counselled.
Whereas in contrast, if for example, an individual is seeking support through public, they sometimes
are coming from health care. So say we have an individual who’s been diagnosed with a
heart condition and needs to quit smoking. They would have that assessment done and go
back out into the community but when they come into the community we would be providing
support such as nicotine replacement therapy or smoking cessation which fits under the
skill development intervention through third party community organizations. And if this
was 15 years ago we would be working hard to create a smoke free environment in that
individual’s workplace and in all the public spaces that they go to. And that’s because
our work is based on assessment which means research and we know the research support
successful smoking cessation happens when you have supportive environments that are
smoke free both workplace and public. And then because we are concerned with people
throughout their lifetime we would also be reaching out to family members such as the
children in that family to give them information schools, to make sure that schools property
are smoke free through or inspection process and make sure that retail advertising of tobacco
is within the legislation. So you start to see how we do a range of activities for any
one issue to make sure that the support is in place throughout the whole life span. For
practitioners to do that type of work the report speaks to a need to be subject matter
experts but also experts in working with local partners in the community and understand data
as it evolves in community. And finally a characteristics stick of health
system is that there’s public accountability or public reporting different than a hospital
board that is not required to have open public board meetings. This final area that I’ve
depicted here relates to accountability. So the survey asks questions about our roles,
our provincial rule the local field role and the role of Public Health Ontario. The reports
don’t spend a lot of time on roles. They feel that they’re articulated clearly now but they
do speak to the challenge of both individual accountability or our role as well as accountability
that we have for the whole system to the public. So what they mean by that is that when there
is a problem it isn’t enough for us as a field to just for example with vaping report that
we’ve done as assessment and we’re going to provide a local ball.
You’ll recall in the report we brought forward about vaping we also brought forward the evidence
around availability, the appealing nature of flavored vaping products as well as advertising.
So, again, we’re bringing forward the research and bringing the accountability in that case
to the province and the feds. So the point being as expressed in the last couple of bullets
because local context and emerging issue like vaping are important to being effective we
need to be working in a mutual respectful working relationship with the province and
a shared responsibility for the public’s health. It would not have been — we would not be
accountable either individually or as system if we had just brought forward a report that
focused on a bylaw. The other half of presentation characteristics or principles of a strong
public health system that these leaders reflected on and had brought forward in these reports
but that are very much similar in nature. The first one is again, this idea that we
are a set of interrelated interdependent players both the province and the field will have
to work together towards a common goal and in fact who are accountable to the public.
One of the report speaks to it as a playing field a team that has both offence and defence
that has to pass the ball but really at the end of the day is accountable to the public
for how we work well together and we certainly saw in particular in the SARS report how we
needed to do that work for corp actively and setup systems to support us.
If we are to work as a team there needs to be if you will a game plan that is developed
jointly. We can strengthen this area by looking at the work that’s done in Québec where instead
of having standards that are implemented by the province and kind of an us and them relationship,
the provincial medical over of health chief medical officer of health joins with leaders
from each of the major health unit areas and develops a 10-year plan. . so if it was 15
years ago this would include the meet to create smoke free work praises, — places and eventually
the smoke free provincial legislation as an example along with all the other areas that
we have injures dishings over. You can see how it doesn’t make sense to develop individual
plans across the province but for some areas such as tuberculosis, it is an issue for Ottawa
and Toronto not so much for rural Ontario. So there needs to be a balance between individual
context, attention paid to priorities as well as priorities that are best done across the
province and in a coordinated way. Interestingly in Québec after they do this
10-year plan the individual they call them regions develop a local response, again, getting
at what in their context is the best way to apply in our case [indiscernible] would be
an example where we’ve got a lot of vaping outlets. There needs to be localization but
there’s a commitment to implement that plan and resources are matched to it. So that’s
the what. Then similarly for the how, we need a mechanism
to come together to plan when we are going to have a particular issue research so that
we know the evidence and we’re not doing it in duplication but we need a mechanism to
organize that. We have this now for a certain extent to some issues. We need to strike that
balance between local adaptation an when we want to work together as a province.
A local health unit area may want to pilot a particular new initiative for scaling up
in the province or may as I mentioned with tobacco legislation we may want to have individual
health departments work together to create as it was done with tobacco local policy bylaws
and then work towards a provincial change. So there’s a pattern there where we can work
both independently and collectively. Stakeholders was an area in this presentation
that they emphasize they are part of how we do our work not just a casual partner and
sufficient workforce who are able to do this local customization and then knowledge to
practice function to other areas that the report mention for strong public health system.
The final areas are quite clear in terms of the experience that you’ve had here at this
board one being stable predictable funding and the other this concept of both independent
accountability as a field or as a province but also joint accountability for how well
we work together to protect and promote the public’s health. So in summary all of these
previous reports had envisioned some form of revitalization. Some of the recommendation
have been implemented, we have 2 major public health agencies now that we didn’t have before
SARS, one being Public Health Ontario, and public health as of Canada.
This kilt takings with the prove victims offers us — realize even more of these recommendation
that were identified by leaders in the field.
I’ll close there. May have some closing comments that she wants to make.
If I may just wrap you the presentation, thank you for providing that presentation.
And I hope it has provided members of the board with some appointments and principles
and thoughts for consideration. As the Ministry of Health embarks on its consultation process.
Just to reiterate a couple of points that were made within the presentation itself,
the province is currently holding an open public consultation process in respect of
public health’s modernization. This is the process that they’ve undertaken.
And that survey is in fact open to all members of the public and to our knowledge what has
been put out there is that — that survey is opened until the 10th of February. We are
also in conversation with the province right now. We understand that they’re working towards
a February 10th consultation date with the City of Toronto just to be clear, their modernization
process has the province has described it is not just with respect to public, they’re
also doing a consultation process around the province in respect of emergency health services.
So the province is currently proposing to hold an in person consultation session with
the City of Toronto on February 10th, half of the day covering public health and half
of the day covering emergency health services or paramedics.
So that’s the — our understanding of the consultation. We’re still working through
some of the details or waiting to hear with respect to what the province has in mind for
that consultation session. But we’re certainly once we have something a little more confirmed
we will be sharing that or presumably the ministry will l with members of the board
so that your active participation can be solicited. So with that I’ll turn it over to you, Mr.
Chair. Thank you. Questions of staff. Yes, director
Donaldson. Thanks. Through you, chair, thank you for
this great presentation. On page 12 you talk about the Québec model.
Can you help me understand the differences a little bit more?
I think what I heard you say is that in Ontario we have legislated standards and in Québec
it’s a little bit different in that they’re not legislated and co-developed, is that correct?
Sure, through the chair, the current system in Ontario has public health standards and
they’re developed, I’ve been on some of their committees they’re developed together with
the field but they are then left to local interpretation and customizing by the field.
And in the case of something like tobacco legislation and before that the bylaws and
even before that work free — smoke free working — smoke free positives and work police station
you can see where there’s strength in having a cord natal approach across the province.
So that did happen with tobacco and it happened in part because of leaders in the province
and leaders locally who came together, but it was more ad hoc and less formal whereas
in Québec as I understand their system they do have a similar system of set of goals or
standards but they also have this approach of a 10-year plan where they look attic issues
and you know, there are many, many issues. Tobacco 15 years ago needed work to create
the current bylaws and tobacco legislation we have, vaping is in a same situation now
where we need to work as a system and this concept of joint accountability comes in.
I’m suggesting that rather than having an ad hoc approach issue by issue with tobacco
or with communicable disease that we create a system where we formally create a plan for
a period of time, commit to local implementation and roll it out.
It’s like in addition to the standards. Just as a follow-up: Is there — so Québec
does a 10-year provincial plan, is there funding that flows alongside that 10-year plan?
How does the funding model work in Québec? To my knowledge there is additional funding
part and parcel of the budget that’s there. Okay. And back to the Ontario public health
standards and because they exist in legislation provincial legislation you said there is some
local interpretation. Is there the static nature of that?
Does that impact Toronto Public Health’s ability to be responsive on the ground?
Through the chair, the wording that’s in the standards varies depending on the research
for a particular issue. So sometimes we know exactly what the intervention needs to be
and there’s a protocol very tightly written for it. It tends to exist in the clinical
services such as communicable diseases or in dental. In others the verbs that are used
are broader so in collaboration with community groups ensure that x and y happens. I don’t
think they limit us, I think they allow us to create that local customization.
Great. Thank you very much. Thank you. Director perks.
Thanks. I just want to make sure I understand the policy development or action development
process you seem to be recommending. So you’re saying have a province-wide plan but customize
locally is that — yeah. So — [away from mic].
I have a question concern about that. So one of the things that I think has been remarkable
about Toronto Public Health is that on many issues smoking included, the Toronto Public
Health system has been able to advocate for things that the province has not yet taken
on. You mentioned smoking. So I remember many years when the Toronto Board of Health was
advocating for removing — for getting smoking out of bars and restaurants and work places
well before the province considered it a problem, similarly the pesticide bylaw actually the
province actively was a problem when we were doing that. So do you see a role in the system
you’re advocating for local health units to generate issues that are not priorities?
Province wide? In short, yes. I’m not suggesting this is
the only way. I just think — and really am reporting what
the reports that reflected on how public — we have
a responsibility to report and to look at the literature and see what is the most effective
way to effect that. In the case of vaping as I mentioned, one
of the effective routes to go is to deal with availability, flavors and advertising. Again,
outside of our jurisdiction but we certainly brought forward that recommendation. So I
would say I’m in agreement with what you’re proposing because we have a role to reflect
what we’re seeing in the community and what we know works in the literature.
And that will be part of our feedback to the province as they do this consultation?
Through the chair, absolutely. And my expectation is as they do this consultation and afford
us that in person half day session, there will be no shortage of opportunity for members
of the board to express that. In respect of that, which is happening at the local level,
the history that you talked about with respect to Toronto, I think what’s interesting about
that is that, yes, Toronto has always played a leadership role in that record, and that
that has been augmented and most successful in the province when it’s Toronto and during
ram and Ottawa. It’s the local partners together that actually bring that real strength and
that make for that change. That needs to happen and has happened in the past with the province.
Thank you very much. Director mulligan.
So thank you for the presentation, thank you, chair.
I do have some questions around the issues for consideration with respect to the public
health modernization paper which is on page 4. There are a few things that are either
asked about in the discussion paper issued by the province or you know, that I think
are important to the mandate of Toronto Public Health that aren’t mentioned here. So one
of them is health equity. I don’t see this mentioned directly in the paper, and so I
guess my first question would be what is the role of local public health and the public
health system in advancing health equity? So through the chair, people who have heard
me speak on what the role and objectives of public health are probably tired of hearing
me say this, but I’m going to say it any way. When I think about public health and when
we think about that which we have to do here at Toronto and I would say public health system
at large, we have 3 major objectives, the first is to improve the health status of the
population, the second is to reduce disparities in the health status of the population, and
the third is to prepare for and respond effectively to outbreaks and emergencies. So by definition,
health equity has to be — it is part and parcel, it’s in the DNA of public health and
it one of our fundamental objectives. So it’s throughout all aspects of public health.
Okay. Secondly, there are references to local decision making and roles and to municipal
decision making and roles. Are these the same thing from the perspective of public health?
So I’m sorry, through the chair, which — where are you — for example scale up locally developed
interventions is one thing or use local community networks to maximize health impacts these
are on page 4. Yeah, so through the chair, I think there
are a couple of different things. Sometimes there are areas that are within the context
of a given municipality. And for others of our partners, a local public health response
is not, you know, exclusive to one particular municipality it’s a series of different municipalities
working together. So it depends on context.
Another thing that isn’t mentioned is the role of data integration and digital health.
What should the position — what should the role of public health be in ensuring, you
know, given the population health assessment role that data can be shared across social
services, health care, public health and so on?
So through the chair, an interesting question and one that actually has a number of different
nuances to it and it all depends on which function we’re talking about. There are some
times where we need to actively share individual level information in order to best protect
and promote the health of the population. There are other times when in fact, all we
needs aggregate data, non-nominal aggregate data. So I don’t think there’s a one size
fits all solution there. I think we need to have a supportive technological environment
that actual facilitates the ability of all partners whether they’re within the public
health system, or whether they’re within the health care system and for the interaction
between those 2 systems we need an environment that actually facilitates the ability for
all of us to do our job and what that looks like actually varies depending on which circumstance
we’re looking at. My next question is about there’s a mention
here of developing — define ago formal working relationship between Ontario health teams,
public health and municipalities. And I notice that the discussion paper asks particularly
about deepening relationships with primary care. So can you tell me a little bit about
what that role might ought to look like from public health perspective?
So through the chair, you know, I don’t have — I don’t think I have an exclusive purview
over that. Certainly I have some influence. The Ontario health teams are very much in
development. So I think and each of them is taking its own unique character and role.
I do believe that when we look at public health there are particular areas where we need to
have effective communication and interaction particularly with primary care.
In the case of for example, work that has to do with individual communicable disease
case management we have an important role there. When we have emerging new infections
we have an important role there. Certainly in respect of immunization we have
important interactions that need to occur with primary care providers.
And to a certain extent, in terms of having conversations around what is actually impacting
on the health status of the population, new and emerging health issues, I think there’s
an important role to have. However, I do think it’s important as well to distinguish that
which is public health from that which is health care primary care being one aspect
of that. There’s much more we could speak to on this issue, but there is — I see them
as not entirely similar roles and certain areas where we need to have greater integration
and frankly some areas where our work may be quite separate from each other. And I think
as the Ontario health teams develop, the nature of our relationship that we would have as
the local public health unit may be quite different from one to the next depending on
what the nature of the Ontario health team is one last question if that’s okay, with
respect to — just going back to — there’s a mention explicit mention around indigenous
health and [indiscernible] in particular as to priority groups. So from the perspective
of Toronto Public Health is — would you support the principle of indigenous health and indigenous
hands? Through the chair, yes.
Thanks. Thank you very much.
Anybody else with questions? Director Wong-Tam.
Yes, just following up on the question of health equity because it’s not explicitly
named in the report, and you did speak about the aggregate data, how do you actually pursue
and achieve the outcome can have health equity if we’re not talking about this aggregated
data? So through the chair, it’s not that all data
is aggregate. We talked about data strategies in a data
environment that actually supports the right data at the right level depending on what
the function is. So fundamentally health equity is built in and actually one of the core objectives
of public health. We are — if we improve health status of the population, but do so
in a manner that actually increases disparity in health status then frankly I would have
to tell you that we have failed. Or we’re not doing our job sufficiently. So I don’t
think — as I was in the previous answer I gave, there isn’t a one size fits all solution.
It’s a question of what issue are we trying to resolve, with whom do we need to partner
and collaborate north to effectively come to resolution on that issue and therefore,
what data do we need? And each of those situations will be different. We talked a lot about health
care and the need to exchange particular information with health care providers, but it may be
just as important to share information with for example, our colleagues at SSHA. Just
as an example. So we need to think about a data system in
an environment that actually, and technology that supports those different functions, and
the exchange of information at the appropriate level with the right partners.
And whose data system will we be relying upon, who’s responsibility is it to collect this
data? So through the chair, I think that this is
part of the conversation that we’re hoping to have with the province.
Right now when it comes to certain systems in public health they are largely provided
courtesy of the provincial government and we are all beholden as local public health
agency to say use their existing systems. They are not always the most flexible. They
don’t always provide all the functions that we’re looking for, and I think that this is
one of those issues where we have an opportunity to engage with our provincial partners, to
talk about the kinds of systems we need across the province and how we come up with systems
and environments and legislation and regulations, et cetera, in technology that actually allows
for the flexibility that we need to manage priorities that exist across the province
but in a way that respects the local context. Just a quick point. The meeting with Toronto
Public Health assuming the meeting is taking place with yourself and other senior public
health officials on February 10th and the chair — [away from mic].
Oh all the of us. So the ministry is coming here?
So — to be clear. [Multiple Speakers].
Through the through the chair, the details are still very much being worked out. And
the province has held a few of these sessions already and frankly each one has been slightly
different one from the next because they’re I think learning as they go along. And I think
that’s fair to say. So our understanding is that they would like to hold a local consultation
here with the City of Toronto and half of the day would be dedicated towards public
health,. My understanding as well is that that would — the invitations would be extend
today members of the Board of Health and senior city officials. Including senior Toronto Public
Health metal and senior city management should they wish to attend.
Just to I guess clarify will we be convening a special meeting of the Board of Health?
So through the chair my understanding is that in our jurisdictions it has not been a special
meeting of the Board of Health it has been a meeting hosted by the province for which
they issue the invitation. So it’s their meeting. And they’re issuing the invitations to those
who have interests and purview over the issue. So just there — they will also be setting
the agenda going through their consultations survey with us?
So — and not to put you on the spot. Yeah.
To answer questions that you don’t have the answers to.
So through the chair, the province actually — so from what we understand with the other
jurisdictions that have already had such meetings, there is a high level agenda that provides
an opportunity. They have a presentation, that’s my understanding of the way these meetings
have gone. The province provides a presentation. And then they open — they have a fairly — it
sounds like a fairly open dialogue, people may ask invitees, participants can ask questions
of them, provide insights make their comments in respect of the consultation paper, presentation
or any other issues related to public health modernization as you see fit.
Okay. Thank you. Director Donaldson, then director perks.
Just to clarify, the survey, is it open to the public?
Through the chair, yes. And to your knowledge, has the — has the
ministry committed to making public the results of the consultation and the survey?
To my knowledge, no. And in terms of the trajectory of this project,
and the timing, has the ministry declared any intentions around when they expect it
to be finished? So through the chair, my understanding is
that the survey itself that public survey it’s available online as open until February
10th. I don’t know when their final consultation in person consultation with jurisdictions
is. I do know that ours is currently they’re targeting February the 10thth and there may
be dates after that, but beyond that, we really don’t know what the wrap up looks like. It
sounds as I have indicated, based on the conversation that we’ve had with other jurisdictions who
have had their in person consultation it sounds like the process that the prove rinse is undertaking
it’s rather fluid. They are adapting their presentation and/or the conversation as they
go along. Thank you.
Thank you. Director perks. Thank you. So I’m struggling with this. I
mean, we’re being asked to give ideas for how public health should be run in the province
of Ontario basically on, you know, 3 weeks notice now. I appreciate the province has
done something, but we as the board are — I mean it’s put in front of us for something
that takes place on February 10th. I see that there’s — there have been some sit down meetings
with Toronto Public Health staff and there’s been an effort to try to build a body there,
but I don’t see reflected in this report which was generated out of that. And I guess the
step that I feel is missing and I’m trying to figure out how we get that step, is an
opportunity for some members of the Board of Health or any, all of us, or some of us
in small groups to sit with some public health staff or at least be given a piece of paper
that says this is what public health staff have raised, these are the kinds of issues
and give as you chance to engage in that. And I’m wondering is there any possibility
of you know, members of the board and Toronto Public Health staff to have a bit of a conversation
before we provide that inn put on the 10th? I realize that’s really fast, but even informally,
there must be something. I’m wondering is this something you can finds an approach for?
So through the chair, I think this presentation was meant to be the beginning of that conversation.
Recognizing that it is January 13th. And this I admit is a very, very rapid process. Right.
The province came out with their paper towards the end of November, by then as you know we’re
starting to move into holiday season and so you know, the — we have some timing challenges
for sure. But this was meant to be the opening — to a conversation.
What I’m going to suggest is we’re happy to put together we are pulling together the information
again the staff session was held also not that long ago as it turns out. So it does
take some time to pull the information together and to summarize it into something that is
actually be, you know, that would be useful for you as a board to engage with. So very
happy to do that. And to start some — and to figure out what makes the most sense,.
We know how very busy your schedule are, how do we set this up so that you’re able to engage
in this meaningful very happy to take that away and communicate with members of the board
offline to figure out what makes sense because you all have very, very busy schedules. We
know we’ve been trying to arrange a few other sessions that have presented some challenges.
Just as a thought. It doesn’t need to be a formal meeting of the whole board it may be
2 or 3 of us are available on a given Tuesday to sit down with some staff, whatever it takes,
but let’s not get constrained by trying to get a formal meeting with all of using to.
Of course. Through the chair, we just have to be mindful of the appropriateness and the
rules of how the board should work, what constitutes a board meeting and what’s seen as appropriate,
but happy to — we will take that offline there are certain, as you know certain standards
that we have to uphold. If it’s not a meeting with a quorum of board
members there are plenty of ways — yes. Board members in the past on an informal basis.
Yeah, absolutely. Thank you. Other questions?
Okay. I have a few. So the province put forward just so we’re all completely on the same page,
province put forward a complete reorganization plan proposed last April?
Yes, sorry, that was a question. In response to a lot of concern and opposition
— [inaudible] is that correct? Largely.
Largely. Subsequent to that the province appointed a special advisor.
That is correct. They then released a discussion paper in late
November. That is correct.
Is there a consultation process but it seems like it is ad hoc and not — it’s not every
board and every public health unit having the same process is that correct?
There appears to be some difference, yes. Has Toronto Public Health had any consultations
with either the special advisor or the ministry on this process, on the actual reorg on this
process? Not to date.
Our last meeting in December we requested this report which is in front of us and we’ve
requested this board a formal meeting with the special advisor and the province. So you
mentioned February 10th, is that confirmed, have they said that they’re going to metal
with the Board of Health on February 10th? I’ve had that eventually.
They’re looking for a contact. I just received notification on Friday that
they’re looking for a contact. I know have that contact for them to start to make arrangements,
and what I have in writing is February 10th. Okay.
They said they’d like to start making arrangements. Okay. And that would be for the Board of Health.
It’s for public health and it is meant to be Board of Health and staff.
Okay. On the substance of what is being discussed here, so the discussion paper and I’ve struggled
in part having read the discussion paper, read the report here from public health staff
is and yourself to understand what are the risks? I mean, what is going well that is
not reflected in the report that we need to ensure is carried forward, and where are the
risks as evidenced in their early discussion paper?
So that is a — that’s a hefty question and I don’t know that I can answer it within the
time that you have. But suffice it to say that there are a number of issues that we
see within the context of the report. The consultation paper and one of the challenges
that emanates that gayle made in the presentation is that public health is actually — it is
a system in and of itself. And it is separate but related to health care and other social
service partners. The way the consultation paper presents things right now it talks about
local public health like it’s its own island and responsible for everything when in fact,
we know there is a provincial role, there’s a federal role, municipal partners, community
agencies that all contribute and the concern that we have, if I had to put it in an overarching,
overriding concern is that the current paper does not view public health appropriately
as a true system of which local public health has a key role, but not the only role.
When I’ve read the discussion paper and that report, local governance I did not see within
the discussion paper. And the importance of a locally responsive and organized body. I
didn’t see the principle of stable and predictable funding referenced.
Others on the board have talked about the role of prevention and health promotion, the
role of health equity, those core tenants, I don’t see identified in their discussion
paper. And so that’s where I see r say where are the areas that — going into — so Toronto
Public Health is in the process right now of preparing a response is that correct?
That is correct. So I’m curious in Toronto Public Health preparing
the response, what are the concerns and the things that must be considered that are not
that you’re planning to bring toward. So through you, Mr. Chair, if you look at
the presentation and actually when you look at our previous reports the board actually
has established responses and has positions that they’ve adopted in respect of public
health. Stable and predictable funding. If you look on your slides it’s on slide 15,
it’s explicitly mentioned there and we actually have mentioned that self times in the past.
Happy to, you know, hit it again, but that has been a fundamental if I can call it a
[indiscernible] we’ve always felt that that was absolutely a must have. Public accountability
I would say the variation on public accountability is actually local accountability. And that
may not necessarily come through on this slide but certainly with the combination of public
accountability and the need to be tied to local community, to be aware of the local
context and to actually be effective in the local context I think local governance is
part and parcel of that, but happy to hit some of those points again although they have
been — they’re quite clear as our positions from the previous interactions with the provincial
government. Okay. Thank you. Those are my questions. Any
other questions? Okay. We’ll move into speakers. To speak.
Director Wong. Thank you very much, Mr. Chair. So when I
saw the report from the medical officer of health with regard to this item I thought
the recommendation for the board was very passive. Because what I saw, Mr. Chair, you
just circumstance lately the motion and the amendment, because we got to communicate to
the ministry, to this province the government because if they’re going to modernize public
health moving forward, whatever they’re going to modernize is going to effect us to the
core whether it’s funding, whether it is the standards or the stuff that we believe in.
And you alluded to some of them Mr. Chair as with others. We really need to make sure
that we verbalize Bowry in writing and those who are attending the February 10th meeting
to indicate what are guiding principles for this board. We have been champion now for
over a year or for many, many years at Toronto Public Health. What I’m concerned about is
if we don’t proactively and I think director perks indicated earlier that we got to make
sure our concerns advocacy work for decades on public health doesn’t get diminished as
they modernize what is public health with the province.
Because at the end of the day this is going to be stuck with us in terms of future funding
but more importantly what is the role for staff but also for our mandate as a board.
So I think that some of the motions that the chair has put forth I think is very valid.
I think we need to move forward with some very strong language what we believe in. Thank
you. Thank you. Director perks.
Thank you. I’m profoundly concerned about this moment for public health. Yes, we did
survive last year a budget attack, but I’m looking at this, I’m just terrified. To begin
with, the word modernization I haven’t a clue what it means.
It can mean anything. There’s — nothing in — anything I’ve seen
communicated from the province of Ontario tells me what is different between the moment
we’re in today and the moment we will be in 10 years from now and how modernizing gets
us from one to the other. It’s an essentially meaningless discourse. And when you’ve got
something meaningless that you’re being asked to participate in, that means you have no
idea what the real outcomes that are imagined by the province might be. And that’s the terrifying
thing. One of the things that I think is most important
about public health is that unlike the rest of the medical system which is dealing with
a patient to improve a health outcome with a disease or something — some treatment or
medicine that you wanted to is public health talks about health on a population level.
And because it talks about health on a population level, it automatically finds itself interrogating
questions of the inequities in our society and the health impacts of those inequities,
in other words it’s built in that it asks hard questions about how our society is organized.
And I fear that when you have a combination of a meaningless process, modernization, and
a specific attack on that part of our health system which raises the difficult questions
about how our society is organized, who benefits and who does not, that we need to be better
prepared than what we’ve been able to achieve in the very short am of time that the province
had provided for us. And I just want everyone to, you know, make it a bit of a priority
over the next couple of weeks to jot down some thoughts, to think about how you can
communicate directly with the chair, or the medical officer of health or find time to
meet in small groups. We need to be able to articulate the case for why public health
is so important to the broad social health outcomes and he can in our city.
— where the — it’s a quote where the — where the results were still have not been made
public. I’m not sure that they ever will. But there’s been several organizations who
have done polling, the feedback from the public has been loud and clear yet the government
refuses to share the results of this consultation. So I would urge this board and the medical
officer to be really explicit about making our needs and our concerns public and I would
also ask that you urge other local public health units to do the same because our communities
really deserve to know and the whole province should know as well. Thank you.
Thank you. Other speakers? Director mulligan.
To build on what the previous directors have said, it’s important that this board take
a leadership stance. We have a reputation nation-wide for taking leadership when it
comes to population health and health equity. The ministry itself has said they have pressed
the reset button on public health, changes to public health and that they’re asking for
vision. And we have an opportunity to put forward a vision, a positive vision of what
we think the role of public health and population health and health equity ought to be in this
province and in this city, and we’re not there yet. And we have not much time. I’m concerned
that the date of our in person consultation is the same date as the date of the end of
consultations. That what, you know, when realistically will we have an opportunity as a board to
sit down and put together a coherent vision for public health and population health in
this province. The timing seems very challenging. The discourse around population health is
worth noting that Ontario health teams and the health care system integration has been
tasked with population health management. Is that the same thing as population health
from a public health perspective who’s going to be responsible for what? I think there
are a lot of questions there, and there — I think it’s important, you know, in the history
of public health modernization papers that have come out over the last 20 or even 30
years, the tendency has been just to push back and say no we won’t relate with the health
care system, we’re a separate system. And I think we need to challenge that. I don’t
think that’s got us where we needing to and we need to have a very Frank conversation
about what is the relationship with the health care system, and those organizations such
as those no n comprehensive primary health care that might Bloor the boundaries more
than predicted in page 8 of the presentation, only deals with individual clients and only
deals with populations. That’s about to change. And how we define a population may change
and what we think about as local inn put, local accountability, local governance whether
or not that needs to be identical with municipal is something that I think we need to have
a conversation about as a board. So I think there are a number of things and
so I just wanted to register my concern about the time. And the opportunity to reiterate
the positive opportunity we have to set forward this vision. Because these consultations,
these kinds of quote unquote modernizations they come and go. This is one.
And it’s our opportunity. If we can clarify a longer term vision of what we think really
needs to happen we can continue working toward that vision regardless of changes in provincial
flavor. Thank you.
Thank you. Any other speakers? All right. I will speak and I’ll begin by placing an
amendment which has been advanced circulate. Let me start first all just by thanking our
staff for bringing forward the presentation and the report in front of us. I know in — when
a discussion paper was released at the end of November we made this request in the beginning
of December and it’s early January, welcome to the process that’s underway. As director
mulligan was just saying there have been decades of discussion in this province related to
public health the organization and funding of public health. Some of those have been
react active in response to a SARS we saw shifts in the funding framework.
I’m not sure what is driving this reorg completely. When I read the discussion paper, I see a
lot of language around coordination, alignment of services but I don’t see discourse of health
equities, population health at large and how you best accomplish those objectives. And
I also don’t see a lot of principles that have guided the effective delivery of public
health’s services and policy over many years with regards to stable funding, local governance
driving the process. And so as we go forward we made a request in December that there is
a direct engagement with this board. And I’m glad that that — it seems like it will be
happening on February 10th, still to be confirmed. I’m not comfortable as a chair or even just
as a member of this board simply going knee a consultation hoping that a good outcome
is going to come from it. I think some clear principles need to be conveyed and communicated
in advance of that meeting. Which my amendment speaks to. And communicated. But I also think
and this is a challenge with how quick the process is and the uncertainty of it is I
do have a level of concern around our preparedness for that and I think director perks was speaking
to this. And so while the amendment I have in front of us is to endorse some clear principles
and on behalf of this board to convey those in advance so we’re more prepared, I think
when it’s clear who is able to attend on the 10th that the onus will be on me and I’ll
ask for the medical officer of health’s support so that those who are attending, so that we
can convene to chat in advance be it to workshop or via conference call. Just also note that
province wide through or office we’re — starting to have conversations with sectors who are
engaged in April within the food policy community, within the nutrition community and we know
that that outreach needs to take place. And so I’ll simply close by saying I — this is
an unconcern moment in public health in this province. The — I believe that the obligation
on us is to more than monitor it but to proactively engage. It’s challenging when we as the local
public health body for Toronto are tasked with coming up with an overarching provincial
model for them because we don’t necessarily have faith in this government but circumstance
requires us to be a little more proactive. So that we do more than successfully stop
a bad decision but proactively help to shape a positive system going forward. And so with
that, I’ll conclude my remarks. Are there any questions of me with the motion? Yes,
director mulligan. My question is around whether we have the
mandate to speak to I want graduation with local municipalities 1a. That are not our
own given that other boards of health [inaudible] differently and not all are explicitly linked
to local municipalities. So the intention here in terms of guiding
principles is to speak to the importance of integration with local municipalities at large.
Rather than to provide a prescribed measure for each and every other one. Okay. Any other
speakers? Okay. Seeing none, then we have an amendment
in front of us. All those in favour? Opposed, if any? That
carries. As amended — nope, just that. Okay. Thank you very much. And thank you to
Eileen, your team. We’ll now move onto our next item which is
item hl13.7 mobile dental clinic 3-month pilot of service delivery model. Do we have any
speakers on this item? We do not. Okay. So there was a report submitted.
Questions of staff? Yes, director Wong-Tam. How many individuals are served by this particular
service, and do we have a breakdown of where they’re coming from the ages and genders?
Yes, through the chair, we see approximately 1,700 clients annually on the mobile bus.
Each individual agency it depends on the demand on that day as we arrive. On average it’s
about 7 clients per day when the bus is at the agency.
And so would you say that each client needs about one hour of assistance like once they’re
into the dental chair? And that includes consultation? Again it varies. Some clients do take more
than an hour, some clients take more than [inaudible] depends on their needs. We basically
design their treatment plan and their consultation and their — when they arrive at the bus.
So on average maybe an hour, maybe a little bit less.
And so because the vehicle requires this extensive repair, can you explain the stopgap in the
service that you’re about to introduce to sort of fill the — to fill the gap? Like
what would that transition look like? Well, we would have our — we currently do
have an outreach worker working the program. The stopgap measure would be to have the worker
plus a clinical staff members member attend the agency and provide the consultation and
their free treatment services done at the local level. And when they do require the
treatment services they would be shuttled driven provided service at the clinical level
at one of our 24 clinics. So therefore, there’s no real plan to replace
the mobile unit? For now we — sorry,. Through the chair, I
think the issue is that the fact that the mobile dental clinic requires this significant
investment, only came to our attention relatively late in the year. So in fact, it is not operable
right now. So this is an opportunity for us to continue to provide services to a population
that really needs this service and is quite vulnerable. And as well to provide service
to a greater number of clients. The model that’s being proposed should allow us to provide
or at least give us the opportunity to provide service to a greater number of clients for
the number of hours of operation. And at the same time that gives us the opportunity to
explore because it does take time to put things through to have a sense as to how much will
it cost to either repair the mobile dental clip in this case or acquire a new one depending
on what the particular, you know, what the assessment of the vehicle provides for us.
We have to do some investigation in order to invest further, and there is — that will
have to be done because given the timing it could not be inserted into the capital budget.
We actually have to make the adjustment to our capital budget within first quarter, so
that all does take unfortunately a little bit of time. What we’re trying to do here
is preserve service in the interim. Under the prior model the street outreach
worker was the individual that drove the mobile dental clinic, and if we were to get this
program up and running, would that still be the best use of the street outreach worker’s
time? Because when you’re driving the bus — when you’re arriving the clinic you’re
not working face-to-face with the population that you’re trying to serve you’re just basically
a driver? Right. I mean, the best, the best use of the
worker’s time is to do outreach in the individual — okay, in the community, however, we’ve
tried to explore many models about driving the bus to the specific location, we’ll have
to explore further, but it was a challenge to get driver to drive the bus for an hour.
To a location. So just to understand, so the revised service
is to actually do the outreach in the communities and the agencies where people are already
receiving other services, and then you’ll be transporting them to the other clinics
that are brick and mortar clinics to get their assessments, the dental treatments that they
need? That’s correct.
Okay. And then a report back? That’s correct.
Thank you. Director Wong.
Thank you, Mr. Chair. So I received a communication from Vicky — about this particular report,
Mr. Chair, through you to the medical officer of health. So this particular deputant asked
that what does she say here, she said she’s encouraging Toronto Public Health to reach
out both mobile dental hygienists to be included in this project. So through you to the medical
officer of health is that being considered as alternative dental model that’s suggested?
Through the chair, I’m — can you repeat that. It’s not — it was a hand note given to the
board members that the — that this particular deputant asked that she’s encouraging the
Toronto Public Health to reach out to “both the mobile denturists and dental hygienists”
to be included in this pilot project. I just want to know if this is being considered for
this 3 months pilot project. So through the chair, that option is not currently
being considered for part of pilot. I would suggest, however, that in part and parcel
of our regular how do we continuously improve our service, if there is benefit to incorporating
different models of care, I think we should always be open and exploring what are the
different models of care and does it make sense within the context of our working environment
and to serve our clients. So that particular re just got the communications as you did
today, we’ll certainly take it back and determine. I don’t think it will be part of this pilot
but certainly happen to look at it as part of how do we constantly improve our service,
is this an opportunity to do that. And my last question to the medical officer
of health, when the 3-month pilot report coming back to the board, can we get an idea within
the new funding from the province for the dental program how would that help especially
those vulnerable residents that we have we supposed to be improving their dental care,
and more importantly, how do we ensure that this is a city-wide initiative? Because often
time I raise that concerns when the mobile clinic was out in Scarborough and we didn’t
really know about it and then we see it in the middle of the parking lot. So it would
be really good in the 3-month pilot project the report comes back to the board, we have
a cross-sectional review, across the system how we deliver this new alternative dental
program. So through the chair, the Ontario seniors
dental care program actually has some very specific requirements of it.
And that actually is service that’s delivered to eligible seniors throughout the province.
And it’s within the context, and I’m going to turn to staff public health clinics, yeah,
any public health clinic through health access centres and chss, community health centres,
excuse me, there are very specific requirements for that funding.
That actually is quite separate from this. That’s not to say that there aren’t vulnerable
and eligible seniors who might actually be taking advantage and capitalizing on the service
we provide or provided through the mobile dental clinics. I can assure you the report
that we bring back will give you a sense as to what we determined through the pilot and
offer some suggestions for you to consider in respect of how best to provide good, quality
dental service to those who need and to those who would benefit most from the model that
has traditionally been delivered thus far. Thank you. Any other questions? Okay. Seeing
none to speak. I’ll put myself on the list. I have an amendment if it can be moved, and
it’s specifically to request the MOH to report at the end of the pilot on the interim delivery
model, the alternate delivery model specifically on two fronts, one is review of the performance
and the second is any information on additional funding required to sustain it.
So let me tell you as I see it, the goal and certain I have, anytime we can enhance the
quality of dental service that is we provide for our Morgan analyzed population, that’s
a good thing that’s what we’re trying to do. Where the concern I would have is the vehicle
breaks down therefore we stop funding the vehicle and we get worst service. That would
be a bad thing. And so I want to thank our staff to — for moving quickly when the vehicle
broke down to come up with a model to ensure the continuity of the service, that’s good,
if we can do it better that’s great. But I want to make sure because I know report mentioned
that we’re going to evaluate it, I would like to ensure that we have the end of this period
a report back to the board with these conversations so that we can evaluate are we ensuring the
level or seeing a reduction in service quality. Any other speakers? Okay. All those in favour
of the amendment and as amended? Any opposed? Seeing none. Okay. Moving onto our final item
hl13.8 subway health impacts study. Do we have — is there — we don’t have a presentation
on this, no we don’t. So we have speakers. There is a speaker listed — Wilson. We see
you at other committees we don’t see you as much here down at the Board of Health. Women.
— welcome. The real work is for cleaning up or mobility
and changing it tends to be at the other committees not so much here even though do you a lot
of good work and it’s been really hectic for you with our — trying to blow up many things
and he’s not getting away with it. Thank you for pushing back.
Decades back I got interested in air pollution issues through acid rain which also we couldn’t
just point fingers at the U.S. We had to have clean hands and look at what
we’re creating within our own city and that lead to mobility issues and cars. I did realize
there’s an awful lot of pollution that you don’t actually see. You can almost see the
pollution sometimes if you have a strong light source, you can see the haze. So if you’re
seeing that sort of haze and beam of light in a subway tunnel now the — if it’s mostly
finally particulate, there’s definitely a problem or a set of problems. So I really
hope that we’ll take it quite seriously. I’m not sure — it’s not so clear from the summary
report where the pollution is coming from, however. What — is it from breaking? — braking.
Contaminate air from street level into the subway tunnels, is it from maintenance and
welding activities is it recirculation of the you know, as a train comes in to a station,
does it push, disturb the dust? It’s not entirely clear from the intermediate level report where
exactly the problem is from. Another issue that I don’t see that it, you
know, again not in the summary and I should have explored further are there any variations
by season, time of day, concentrated in the older parts of the system, it is an older
part versus an older — part of the system versus line 2, or line 1 which is very extended
now with new stations. So is it concentrated in the old parts of
the system? And I think your options to fix it are a little weak unless unfortunately.
One option that might actually help is to try spray painting to see if that actually
helpings to seal in some of it especially as you approach stations perhaps.
Could be wrong. At least give it a try, see if it makes a difference. And one of the other
things that I think is really important there’s another wonderful mobility option instead
of just saying to people hey keep on taking the subway and paying a lot for it, why not
really encourage better biking along the Bloor and Danforth.
That should be part of the public health solution proposal to alleviate the air pollution because
it’s not just about the safety of the passengers within the — within the system.
Biking is much, much better for us all told. And we should know by now that we actually
have a lot of independent up, yes this comes up, we have a lot of interesting by seeing
cycling on the Danforth, Bloor Danforth has been consistently one of more traveled corridors
and doesn’t have the streetcar tracks which actually create a lot of issue for people.
So it would be easy to repaint. I know we’re studying it again to repaint things. So it
would be great to have the Board of Health expressed support for having a continuous
bike way all along Bloor and Danforth. We’re studying it this year but unfortunately there’s
also a key gap that’s being missed, it seems, have I got this the right way, somehow from
over to church that little bit is was in the 2001 bike plan the remnant of stage 1 from
the 1992 studied dee, that’s still not good enough. And I think it’s missed in all the
studying that’s going on, so, please, please, please it would be really helpful to support
a bike way try and get something done this year.
Doesn’t have to be a bike lane right away. I’d be happy with the share because it will
be something. That’s a condo construction. I’m almost out of time. Another thing that
would be really helpful is to encourage the city to actually do better job on the winter
maintenance. This is from last year, a pinch point a highway on Bloor east, the bike lane
becomes a bike line often and that’s not okay. Unfortunately we have less competent in the
repaving as well, — fresh repaving which was wonderful.
There was a bike lane at the same time around the curve prior to painting and then recently
we just had repaving but it’s still not okay. You know, it’s a pinch appointments. So in
order to really have that mobility option made safe which is something that you should
do to respect all the transit users because this is sort of how we’re at there is a pedestrian
there, there’s a bike, that’s your subway, there’s your transit and there’s the private
car. Thank you, I’m over time. I’d love to go on, but thank you for your
time and trouble. And there’s an awful lot of hazard on street and it has to be made
safe. One final, final thing. Sorry, you’re already, just over time.
Yes. It will be great to have a — in terms of road safety great to ask the — for a review
of all the crashes in the last decade to see if the lack of enforcement has actually contributed
to real mortality. Okay. Thank you very much.
Are there any other members of the public here who wish to speak on this item? Okay.
Seeing none, we’re going to move it into committee then. We’ll start with questions of staff.
And I note for members of the board, we have — we have a report here from the medical
officer of health but we do have staff here from the TTC if there are questions of them
as well. Okay. Let me open it up.
Questions from staff. Or questions to staff. Director Wong.
Thank you, Mr. Chair. So through you to the medical health with regard to this report
it focused primarily on the health benefits or the issues affecting the health of the
passenger. There’s no references that I read dealing with the workers, because we’re just
visiting the subway yet are we not concerned about the employees of the TTC? Who’s there
longer than we will be on the subway? So through the chair, as medical officer of
health, I have authority on the public but not in respect of matters that relate to optional
health and safety. Thank you.
That falls under the purview of the Toronto Transit Commission itself.
Okay. That’s what I wanted to know. Thank you.
Thank you. So I have a couple questions. I think members of this — of the board probably
had time to drill down into this. It’s been very prominent for the last little while.
As it relates to pm 2.5, the fine particulate matter am I correct in my understanding that
there are no guidelines at the federal level or at any other level of — to what the level
of pm 2.5 should be for passengers? In short, through you, Mr. Chair, that’s correct.
So I know in doing the independent health assessment you have assessed that there’s
no immediate risk in fact, I’ve seen this that the advice is that taking the subway
is good for your health, but could be made even better with mitigation, but why not — why
no recommendation or request for the federal government earlier to create guidelines on
pm 2.5, so it’s not up to us on our own? So through you, Mr. Chair, clearly it would
not be up to us on our own. And I think it’s reasonable to ask for those guidelines to
be created or standards. I expect that it might be challenging for some of our federal
partners to do that. There is no — we know that pm 2.5 is one
of those exposures, if you will, that really doesn’t have a threshold, or no known threshold
but I expect that our counterparts would have some challenge in putting those together.
I don’t think there’s a handle in asking I just expect we should have reasonable expectation
around what might emanate. And I know this is an emerging issue for subway
systems around the world, London and Paris and others have looked into this. Have other
nations or our jurisdictions established clear guidelines around the level of pm2.5?
Through you, Mr. Chair, no, we know of no such guidelines that have been established,
we know you know there is interest and people are looking into this. This is a relatively
new challenge and other subway systems around the world are also trying to, you know, manage
and figure their way through this. Okay. And then I recognize I summarized your
part to the beginning move question. So I’d like to give you the opportunity in your — in
your assessment and is taking the subway good for public health today?
So in short, through you, Mr. Chair, when we did a health impact assessment and the
overall conclusion of the health impact assessment is that taking the subway and encouraging
subway use is something that we should be doing both as a Board of Health as a public
health department and should be encouraging people throughout the city for a wide variety
of reasons. There are a number of positive health benefits.
Okay — for — articulated in the report. And for passengers, our riders in the city
on subway is there an immediate health risk based on the level of fine particulate matter
that’s been identified. The assessment included that had no we should
be encouraging people to continue to ride subway, that being said, levels of pm2.5 as
recorded in the study suggests that there is benefit to mitigation and that by engaging
in those mitigation actions we would enhance the health benefits of riding the subway and
using public transit. Okay. While there is no immediate risk with
further mitigation it will improve — it will have health benefits.
Yes. Okay. Thank you. Those are all my questions.
Director Donaldson. Thanks. Through you, chair if I — thank you
for this report. I noticed on page 7 there’s a section entitled mitigation is especially
important for line 2. And it says that the pm2.5 exposure level during weekday rush hours
for line 1 — I actually don’t know how to say that measurement.
Micro — micrograms. Micrograms and on line 2 it’s 183. So in the
findings of Toronto Public Health, are there factors that we determined that are contributing
to a hundred point difference between the two lines.
The factors have are not really entirely clear. And we know that that’s not only the case
for Toronto but it seems to be the case as well based on our assessment for the other
jurisdictions as well. So that’s why there’s a real opportunity and for the TTC to engage
in this and to conduct further study in partnership with health Canada and with the industry and
other researchers, that’s what’s referred to in the report.
Okay. Thank you. Okay. Director mulligan.
Thank you for this piece of work. I have a quick question about risk communication which
I think is part of the underlying unspoken work of this. You know, so, okay, let me just
get right to it. Under 2d monitoring levels of subway pm2.5 and evaluating, is the intention
that given that these would be monitored, that the monitoring results would be made
public? So through the chair the monitoring that has
been done to date has been done through in partnership between the TTC and health Canada
and some other research partners brought onboard. Our understanding is that collaboration is
expected to continue and to date, most of the results have been coming out through publication.
So I further public reporting from health Canada would be a question that we would have
to direct to health Canada. Okay. So in follow-up to that, do you see
there may be an emerging role for Toronto — [indiscernible] and understanding those
results? So through the chair, I think there’s always
been a role for Toronto Public Health in respect of contextualizing results of studies where
it’s with respect to air quality or any other exposure in the city so people can understand
what the circumstances are here. That being said, the monitoring and the studies
and collaboration are actually occurring between the TTC and their other research partners
which include health Canada. So given that you said there’s no established
safe level of exposure on what basis are the decisions made around what constitutes risk
and harm? Well, I think the issue here in respect of
pm2.5 and I’ll ask staff to contribute further if they feel that I’ve missed an important
point, but there is exposure to pm2.5 regardless, right, pm2.5 exists in our environment. There’s
an opportunity to actually rectify what’s happening currently and to mitigate what’s
happening currently in this environment as described in the report. The thing is that
we know that if we do not encourage greater use of public transit and other forms of active
transportation for the reasons articulated in the report, actually there is risk associated
with the broader environment and actually degrading our external environment even further.
So there is an opportunity, this is still an emerging area of research. We are just
starting to understand pm2.5 employees showers within the subway. That is not unique to Toronto
that is in all other subway systems similar to that which we see in Toronto. So we now
know something knew that we didn’t know before relatively recently and we have I think a
responsibility and an obligation to work with our partners to ensure that we address that.
How it’s best addressed, I think is still very much a question and is an area of further
study and conversation within subway service providers amongst the research community and
I would say among health authorities at large. Thank you. Director Wong-Tam.
Yes, thank you. Recognizing that the particulate matter in the subway tunnels and platform
is 2.5, what is just to compare, what is a normal reading in an environment just above
grade? So through the chair, when we talk about regular
in our city for example, above ground is in the range of 7 to 10 micrograms per cubic
metre. And so with respect to I think the — is still
here, he asked some questions which I don’t believe are answered in the report but what
is causing the increase of the density of particular matter in the subway tunnels and
platforms, is it the brakes the lock of external intake circulation? Why the higher concentration,
this is probably a question for TTC. So through the chair, it probably is better
answered by our colleagues at the subway, but I would tell you this, my understanding
is that that has yet to be determined. Those are all reasonable hypotheses but the definitive
answer has yet to be determined. Again, this is a relatively new understanding that we’re
coming to. And when I say we, I don’t mean just Toronto, I’m talking about subway system
operators at large. Thank you.
Or operators of similar subway systems let me be clear about that.
Maybe I could ask does the TTC staff have anything to add to that? Are they here?
Through the chair, not particularly at this time. We do have some hypotheses but a lot
of the materials are consumables. So it’s steel rail on steel wheels and these do deteriorate
over time but doesn’t seem to be a sort of smoking gun at this time that we can pinpoint
to. Thank you, that’s somewhat helpful, but because
the report speaks to the fact that this is a somewhat of an acceptable level but should
try to reduce the density of this particular matter in the subway it’s also speaks to the
fact that there could be effects for those who have respiratory chronic respiratory challenges,
I’m a sufferer of asthma. So oftentimes when people tell me that the environment is accessible
to someone who’s actually living with respiratory challenge it’s actually not very accessible.
How do you distinguish between what is acceptable and not is acceptable especially for those
who are actually living with respiratory challenges, lung or heart disease?
So through the chair, this report speaks to the general population at large. And it is
a, you know an assessment and it talks about the health impact assessment and provides
advice in general that taking the subway, using public transit is actually a good health
promoting, health supporting endeavour. That being said for individuals who have very specific
medical concerns and medical conditions, whether we’re talking about heart or lung conditions,
the advice that we’ve provide issed that if you have those concerns and are having, you
know, particular challenges or have questions in respect of what’s best for you as an individual,
that’s done we feel, best in the context of a conversation with your health care provider
who’s knowledgeable around your specific medical conditions and what triggers worsening or
exacerbation of your medical condition. That cannot be done in a general level.
Okay, thank you I would have some difficult imagining that a medical practitioner suggesting
to a patient I’m going to advice you to avoid taking the subway because there may be an
environmental trigger in the tunnels and platform to your respiratory challenge.
That — sorry, through the chair, that may be the case. But in fact, in medical practice
we know that there are a number of conditions. So for example on those really hot, smog gee
days we know that medical providers will often tell their patients who suffer from more extreme
forms of heart or lung disease to be mindful around perhaps not engaging in vigorous activity
or exercise outside. So those kinds of individual sort of individually focused pieces of advice
are best offered in that context, you know, or increase the use, or what have you those
are the kind of things that can happen within that context.
Okay. Thank you. Okay. Any other questions?
Seeing none, to speak. Director Donaldson. Thanks. Through you, chair, I just wanted
to highlight a motion that I’ve put forward, is this the appropriate time?
Um-hum. In respect of placing a priority on line 2
and we’re looking at mitigation factors. A number of times in the report it’s mentioned
that our findings show that there is a difference between line 1 and line 2. So I think it behooves
this board to ensure that we’re making sure that’s highlighted that there are some differences
in line 2 and to also give the good folk who are riding line 2 every day a little bit of
assurance that the Board of Health is looking out for them.
Thank you. Okay. That amendment has been placed. Anybody else to speak? All right. I’ll make
a few comments. If I could begin by placing an amendment that the board encourage health
Canada to continue its research on air quality issues in the TTC and to establish health-based
guidelines for pm2.5 in subways. So let me begin first of all, by thanking
our staff. A request was made in 2017, for Toronto Public Health to assess the air quality
for passengers within our subway system. And an exceptionally large amount of good work
has been done and a hard work to get to this point perform as we’ve seen in the report
and heard the issue of air quality and air quality within subways is an emerging issue
around the world in subway systems. And I think if there’s a message here, the message
for residents is certainly that our subways are indeed safe, but with further mitigation,
there can be further health benefits. So that’s to me, the message to residents.
I think the message to the TTC, and we’ve heard them welcome this report and express
their thanks not only to Toronto Public Health for the report but also their commitment to
conduct mitigation I think if there’s a message to the TTC to aspire to be a world leader
when it comes to air quality. Don’t be satisfied with a pass from the medical officer of health.
Use this as an opportunity in partnership to further improve the quality and air quality.
I think if there’s a message to the federal government and health Canada in particular
it’s not only to continue that research, but to establish health-based guidelines. So that
you don’t have an ad hoc situation where different jurisdictions looking at this issue differently
and coming up with their own conclusions. And so in conclusion, this is not — this
report here is going to City Council. It will also be at the TTC board. And I know director
McKelvie here is on the TTC board as well as one of the commissioners. So this is not
the end of it by any stretch but also I think it reflects and enforces the role in the city.
— rather we’re a partner in this. And a partner in not only helping to identify and assess
potential health impacts but also to improve them. Just as the TTC has embraced this work
in this report this is a signal and an open invitation from us to continue to work in
collaboration to further mitigation and improve the health. And with that, are there any other
speakers? Okay. Seeing none we have 2 amendments. Do we want
to take everything as a package, the amendments and the motions? Can I ask for a recorded
vote on this one for the board? So all in favour of the 2 amendments and adopt
as amended? Director Bowry, director Donaldson, director
Layton, director Wong-Tam, director Cressy, director McKelvie, director mulligan, director
perks, director Peter Wong and director Soo wrong. And that carries.
All right. So that concludes our meeting. So thank you very much. A very happy new year
to everybody and we’ll see you all soon.

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