Agenda

There are no direct financial impacts arising from this report beyond what has already been approved in the current year's budget.

The Medical Officer of Health recommends that:

1.         The Board of Health endorse the request for a $381,879 net increase to the Toronto Public Health 2015 Operating Budget to cover the increased cost of food for existing student nutrition programs;

2.         The Board of Health endorse the request for an additional net increase of $963,658 to the Toronto Public Health 2015 Operating Budget to be allocated to existing student nutrition programs to increase the City's investment rate to 16 percent of total program costs from 14 percent in 2014, providing a stronger funding base for existing programs;

3.         The Board of Health endorse the request for an additional net increase of $555,542 to the Toronto Public Health 2015 Operating Budget to extend municipal funding for 27 new student nutrition programs to open in publically funded schools in higher need communities in 2015;

4.         The Board of Health forward this report to the Budget Committee with the Toronto Public Health 2015 Operating Budget Request for consideration; and

5.         The Board of Health forward this report to the Premier of Ontario, the Ontario Ministers of Children and Youth Services (MCYS), Health and Long-Term Care, Education, and Agriculture, Food and Rural Affairs (OMAFRA), the Federal Minister of Health, the Toronto District School Board, the Toronto Catholic District School Board, le Conseil scolaire Viamonde, le Conseil scolaire de district catholique Centre-Sud, the Toronto Foundation for Student Success (TFSS), the Angel Foundation for Learning (AFL), and the Toronto Partners for Student Nutrition (TPSN).

In 2012, the Board of Health endorsed a five-year plan to strengthen student nutrition programs in Toronto.  City Council approved a funding enhancement to the Student Nutrition Program in the first and second years of the plan.  This report provides an update on the impact of the municipal investment to date and outlines a request to increase the 2015 Operating Budget for the third year of the plan by $1,901,079 aimed at covering inflationary increases, incrementally increasing the City's investment rate to 16 percent of total program costs, and funding for 27 new programs schools serving higher need communities.  The report also outlines the context in which fundraising for Toronto's student nutrition programs occur.

Student nutrition programs are currently supported through a cost-shared partnership funding model between parents/community, municipal, provincial, and private sectors.  An increase in the municipal investment demonstrates the City's commitment to invest in children and clearly signals a call to action to other sectors and levels of government.

The City of Toronto's Board of Health (BOH) requested the Medical Officer of Health (MOH) to work with relevant municipal divisions to update the City of Toronto's Municipal Alcohol Policy (MAP) in June 2011.  The MAP reduces alcohol-related risks and promotes the health and safety of people at events on City owned and operated property by outlining the requirements for a responsible, managed approach to alcohol service. The last update of this policy occurred in March 2001, when the MAP was harmonized after municipal amalgamation.  It is appropriate after more than a decade to review the policy to ensure it reflects current evidence on reducing alcohol-related harms and liabilities.

Toronto Public Health has completed a comprehensive review and analysis of the MAP, including consultations with municipal and external stakeholders.  Based on the consultation findings, review of MAPs in other jurisdictions and a review of the health evidence on harms related to excessive alcohol consumption, this report recommends the Board of Health and City Council approve the revised MAP. Specifically, this report summarizes proposed enhancements to the existing MAP in relation to designation of properties and events, insurance requirements, safe transportation, signage, enforcement and monitoring of compliance.  Further, TPH proposes that a short-term interdivisional task group be created to develop an implementation plan in order to communicate the changes effectively and monitor and evaluate the implementation of the updated policy.

There are no direct financial implications arising from this report beyond those approved in the current year's budget.

The Medical Officer of Health recommends that:

1.         City Council direct the General Manager of Toronto Water, in consultation with the Medical Officer of Health, to explore the following options to improve the Lead in Drinking Water Mitigation Strategy, and report to the Public Works and Infrastructure Committee in early 2015:

a.         Expand the distribution of free filters to vulnerable populations living in pre-1950s homes; and

b.         Develop and promote a publicly accessible database and/or map of the status of lead service lines.

2.         City Council direct the General Manager of Toronto Water, in collaboration with the Medical Officer of Health, to evaluate current public education and outreach efforts and implement enhancements as necessary to reduce exposures to lead in drinking water, particularly for those populations that are most at risk;

3.         The Board of Health endorse the recommendation presented at the Public Works and Infrastructure Committee on August 13, 2014 for City Council to authorize the General Manager of Toronto Water and the Deputy City Manager and Chief Financial Officer to report back on the proposed details of a program to financially support homeowners to replace their portion of the lead water service line through a loan program from the City of Toronto secured as a local improvement charge on their property;

4.         The Minister of the Environment and Climate Change direct the Ontario Drinking Water Advisory Council to review and provide a recommendation on updating the Drinking Water Quality Standard for lead to ensure it is adequately protective of health; and

5.         This report be forwarded to the Minister of Environment and Climate Change, the Chief Medical Officer of Health, Public Health Ontario, Toronto Catholic District School Board, Toronto District School Board, Conseil scolaire Viamonde, Conseil scolaire de district catholique Centre-Sud, Toronto Real Estate Board and Health Canada.

Lead exposure is associated with neurodevelopmental, neurodegenerative, cardiovascular, renal, and reproductive effects. Lead adversely affects those that are most vulnerable in our society: infants, children and pregnant women. While exposures to lead continue to decrease in the general population, studies show that remaining exposures to lead should be minimized or eliminated whenever possible. Reducing lead in drinking water is considered to be one of the most feasible and least expensive options available to reduce exposures to lead.

This report provides a summary of recent research on the health impacts of lead in drinking water. An overview of lead levels and protocols with respect to school drinking water is also provided. Lead components exist in both the public and private side of the drinking water system and there are important actions that both the City and the public should take to reduce exposures. This report provides an update on the City's efforts to engage and encourage the public to take actions to mitigate exposure to lead in drinking water.

Research shows that homeowners are more likely to take action to reduce their exposures to lead in drinking water when their drinking water is found to be in excess of the drinking water quality standard. Ontario's drinking water quality standard should be reviewed to ensure it reflects current understanding of the health impacts of lead exposure and that it is protective of the most vulnerable in our society.

This report provides an assessment of the health impacts of the City of Toronto's Lead in Drinking Water Mitigation Strategy and provides options and recommendations for additional actions the City can take to further reduce risks from exposure to lead in drinking water.

There are no financial implications of this report for Toronto Public Health.

In December 2013, the Ontario government announced its intent to integrate all provincially funded dental programs for children and youth. The integration of these programs should improve efficiency and simplify understanding of the benefits of government funded dental programs for eligible families and care providers. 

However, the Province has also indicated that they will be removing clinical preventive oral health services from the Ontario Public Health Standards (OPHS) and this will mean that as of August 2015; publicly funded dental prevention services will only be available to children and youth in families who can establish financial eligibility for the new integrated dental program. From a public health perspective, this is a step away from the public health goal of universal access that will lead to a decline in the oral health of children whose families become ineligible under the new program. 

This report recommends that the Ministry of Health and Long-Term Care (MOHLTC) maintain clinical preventive oral health services in the OPHS under current eligibility criteria.

Under the current Children In Need Of Treatment (CINOT) program, children with an urgent dental condition are eligible for one full course of treatment to restore dental health. This eligibility would be lost for some children under the new integrated program, and this report recommends that it be retained.

There are no financial impacts arising from this report.

This report provides an update to the Board of Health (BOH) on the progress of Toronto Public Health's (TPH) collection of socio-demographic data, as directed by the BOH in November 2013. Specifically, this report provides information on a socio-demographic data collection tool that was piloted at TPH, the strategy for ongoing data collection, as well as consultations with key stakeholders including the City Manager on strategies to influence the broad-based collection of this type of data.

This report provides the Board of Health (BOH) with the results of the process evaluation of the Toronto Urban Health Fund (TUHF) conducted for the 2014 funding cycle. The purpose of the evaluation was to assess the newly-implemented application and review process to identify areas of improvement for future funding cycles as part of Toronto Public Health's (TPH) commitment to continuous quality improvement.

The evaluation revealed that the majority of funding applicants were satisfied with the application and review process.  Between 60-80 percent of applicants reported being satisfied with the application, review, and allocations process.  However, areas for improvement were identified, such as enhancing TUHF promotion and outreach to reach key populations; improving the application, scoring and assessments tools; supporting key populations to increase their capacity to use evidence informed practices; enhancing the support and orientation provided to the Review Panel; and adjusting the timelines and structure of the review and appeal process. TPH will implement these changes in time for the 2015 funding cycle.  A copy of the evaluation report is available on the TPH website: http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=173ab622cce32410VgnVCM10000071d60f89RCRD.

This report provides the Board of Health (BOH) with a summary of the results of Toronto Public Health's (TPH) performance on 2013 indicators, set out in the 2011-2013 Accountability Agreement (the Agreement) between the Ministry of Health and Long-Term Care (MOHLTC) and the BOH.

The Deputy City Manager and Chief Financial Officer has reviewed this report and agrees with the financial impact information.

The Deputy City Manager and Chief Financial Officer has reviewed this report and agrees with the financial impact information.