e e e e e e e e e e e e in person and remotely we ask every one for their patience with any delays and technical issues if you are registered to speak at today's meeting please listen for me to call your name I will call speakers in the order they appear on the list the list of speakers can be viewed online by visiting the Board of Health page at toronto.ca counil and click in the speaker box for today's meeting the board secretary has conf provided all agenda materials on toronto.ca counil and uh V CMP the clerk's meeting portal directors please keep your mic muted unless you wish to question staff or speak to an item and ensure that your video is turned on as part of each agenda item I will ask directors to raise their hand or on mute their mic if they wish to speak or ask a question I will then create a speaker list and we'll call on directors when it is their turn to speak when voting on an item or motion I ask the directors ensure that they turn on their video and to raise their hand to indicate their vote directors I want to remind you that you must submit your and approve your motions by email staff are available at B toronto.ca to help with motions the Board of Health acknowledges the land we are meeting on is the traditional territories of many nations including the Miss sagas of the credit the ANC the chipa the Hodo and the wind that peoples and is now home to many diverse First Nations inyard and mate peoples we also acknowledge that tronto is covered by treaty 13 with the Miss sagas of the credit the city of Toronto acknowledges all treaty peoples including those who came here as settlers and migrants either in this generation or in Generations past and those of us who came here involuntarily particularly those brought to these lands as a result of the transatlantic slave trade and slavery we pay tribute to those ancestors of African origin and descent are there any Declarations of Interest under the municipal conflict of interest act if you have an interest please raise your hand and unmute your mic and indicate the item number the nature of the interest I am seeing none we need a motion to confirm the minutes from our regular board meeting on July 8th 2024 and a special meeting on July 9th 2024 for uh director tendra Balon all those in favor opposed carried thank you so again good morning and welcome back to everyone in the room and online since last since we last met Toronto Public Health has been hard at work responding to public health events and preparing for the budget season here at City Hall on August 13th the World Health Organization declared impo a global Health crisis while risk of serious illness remains low because the strain of the disease we are seeing in Toronto is different from the one recently identified in Africa it is still important to uh for eligible residents to get vaccinated against empo dorona public health has been uh hosting empo vaccination in clinics and vaccine appointments are offered by local 2sl plus Sexual Health Care Providers across the city however we acknowledge that some eligible residents have not been able to secure an appointment and are working to improve vaccine delivery for more information about vaccine uh booking you can email Public Health toronto.ca in other public health news last month The Province announced changes to the regulation of safe consumption sites and $378 million in funding for new treatment hubs following this announcement tph was notified by the province that the supervised consumption services at 277 Victoria Street must cease by March 31st 2025 while we welcome additional support for treatment and Supportive Housing as part of a full Continuum of Care for people living with substance use challenges we know there will be detrimental impacts on our communities as a result of SCS closures Toronto continues to be in the midst of a drug toxicity epidemic rates of rates of nonfatal and fatal drug toxicity the overdose including those due to fenol remains High Closing Services that are successful in reducing drug related harms is extremely dangerous both for people who use drugs and for the broader public despite policy changes that are out of our hands the city of Toronto continues its work to address mental health and substance use today we will appoint 12 members of the our health our city implementation panel these individuals bring with them a wide range of insight and expertise including lived and living experience with mental health and substance use to guide annual priorities promote action on recommendations and provide feedback on progress thank you to the over 160 candidates who applied and to Deputy Mayor Malik for leading the process as chair of the implementation panel looking ahead to the end of the month I want to recognize the national day of for Truth and Reconciliation on September 30th when we will honor the resilience strength and stories of indigenous survivors of resal schools as well as those children who never returned home the day serves as a reminder of Canada's ongoing commitment to advancing reconciliation fostering respectful relationships and supporting indigenous peoples in healing and Recovery finally I would like to acknowledge the departure of Tonto public Health's director of communications Megan kilty joining Toronto Public Health in 2021 amidst the chaos of covid-19 response Megan quickly Pro proved as she was the perfect fit for the dynamic role in the years since she has used her expertise and strategic Vision to help us navigate through countless public health challenges communicating crucial information to Public Health with intention and Care in June Megan led the Toronto Public Health Communications team to win two Ovation awards from the International Association of business communicators the Award of Excellence in government Communications for our empo campaign an award of Distinction named J Public Health Communications as Communications Department for the year please join me in congratulating Megan and expressing our deepest gratitude for her countless contributions to Toronto Public Health Megan thank you for your unwavering dedication and exceptional service we're incredibly fortunate to have had you on our team thank you now now turn over to Dr Dilla thank you chair Moyes and good morning to the members of the board here we are it's September and September is often characterized as a fresh start after after the summer break but as you've just heard from the chair this summer has been anything but quiet for Toronto public health and significant changes are on the horizon for public health in Ontario as you've heard this includes the Ontario government's decision to close five supervised consumption sites in Toronto by March 2025 including our own service at the works this shift comes as part of the province's launch of its homelessness and addiction recovery treatment or heart hubs demonstration project meant to provide treatment and Recovery support for those facing addiction homelessness and mental health challenges and as mentioned by the chair these changes have certainly raised concerns but we at tph remain committed to meeting the needs of our most vulnerable populations Beyond these structural changes over the summer months we've tackled multiple Public Health priorities as you know Toronto has endured several heat waves prompting Swift action to ensure our residents were safe and informed our infectious diseases surveillance remains robust addressing a Resurgence in cases of measles invasive meninga Cal disease pusis empo just to name a few and of course we provided targeted vaccination campaigns and Outreach efforts in a addressing these situations there's also positive news childhood immunization demand is increasing post pandemic and we're actively supporting families throughout the city we've also intensified our efforts to combat youth vaping providing resources to schools and Educators to protect the health of our young people including a new vaping cessation program to support Toronto's Educators core public health programs like health and inspections mosquito control Beach water quality monitoring and vaccination clinics were also active and in full swing working to ensure the health and safety of our city and in the past few days alone we've heard of a human case of rabes in this province the first acquired in Ontario since 1967 and the identification of an h5n1 influenza or bird flu case in an individual in the United States with no known exposure to infected animals or birds all this is to say that our environment is constantly shifting with new developments and issues arising all the time as a small example which you'll actually have the benefit of hearing a little bit about today the budget considered by the board of Health's budget committee has changed not once but twice since their meeting and that was just a month ago but thanks to the quick and efficient work of our colleagues in our business and operations team at Toronto Public Health we've continued to be able to adapt to new directions to funding updates and to emerging priorities and while I provide this information to you as context for today's discussions particularly our discussion on the 2025 budget I would like to take a moment to acknowledge that the vast majority of our financial resourcing at Toronto Public Health goes towards Staffing the people of Toronto Public Health are at the core of all that we do they are the foundation of this organization and they are the reason that we are able to respond to the Ever Changing landscape this is why in our recently approved strategic plan we have a priority focused on our people and our culture and it is also why I would like to take the time once again to thank the dedicated Toronto Public Health Team despite the evolving challenges and shifting priorities despite our fatigue and I do use that word deliberately there is a great deal of fatigue despite that fatigue and the constant need to respond our staff continue to innovate adapt and serve our city with true excellence and if the board will indulge me just for a little bit more as the chair has already done I would like to give special thanks to one particular member of the Toronto Public Health team as you've heard Megan kilty joined Toronto Public Health in March of 2021 just as our covid response was a little over a year old and as our vaccine clinic were in their earliest days I think that her joining our organization at that time says a lot about Megan's commitment to our mission at Toronto Public Health her commitment to the city and her approach to challenging circumstances and since that time there has been no shortage of challenge certainly not in our world and through out every single one of those challenges Megan has been as solid as a rock always bringing her strategic insights her formidable communication skills and what I have described as a cheerful pragmatism to the work of helping us communicate with our public and our many partners and stakeholders in service of the people of Toronto Megan kilty will be leaving us to take up the role of Chief public affairs officer at the financial services regulatory authority of Ontario so this will be her last Board of Health meeting so Megan from all of us to you you have been an incredible Communicator a remarkable professional a model public servant the truest of colleagues and someone whom we are are very very proud to call our friend our sincerest and deepest thanks to you and our very very best wishes as you embark on your new role the fs is incredibly lucky to have you joining their team [Applause] so with that thank you uh chair Moyes and board members for your patience with me and with that I will now turn the mic back over to you Mr chair yeah thank you Dr Dilla um so we will now review the agenda uh I do have one new business item I did circulate that earlier I need to vote on that yep put up on the screen it's really around the MX um making it more accessible and available uh for providers to um to give it because right now it's limited as to who can give it and how much so I'd like to add that to the agenda all those in favor we got to vote all those in favor opposed carried thank you item HL 16.1 update from the medical office of Health hiring committee uh there's a pres presentation on this item so I'll hold it down uh item HL 16.2 Toronto Public Health 2025 operating budget submission there's also presentation on this item so I'll hold it down uh HL 16.3 CH of Public Health 2025 20 to 2034 capital budget and plan request there's also presentation here so I'll hold this item down item HL 16.4 Toral Public Health operating budget variance for the six month end to June 30th 2024 with anyone like to hold this item uh seeing none uh director chanen you want to move this item all those in favor oppos carried uh HL 16.5 Toronto Public Health capital budget variance for the six month ending June 30th 2024 would anyone like to hold this item see you want to hold it sure or you want to move it do you want to hold this item to speak to it or do you want to or you want to move it okay um okay all those in favor oppos Carri cared item uh HR 16.6 Mile Dental Care Program 20125 update pardon I would like to hold that item chair you want to hold it okay item HL 16.7 appointment of members to the our health our city implementation panel anyone like to dep Malik okay you want me to hold it down okay all right so members I'd like to propose the following um for today's agenda we do have quite a large speakers list for item 16.2 um I'm going to ask that we close the speakers list at 10 a.m. I do have a motion for that screen the speakers who have not register pre-registered be allowed to register to speak until 10:00 a.m. all those in favor opposed carried thank you Mr chair sorry go ahead go ahead uh councelor perks uh Mr chair I just wanted to alert you I I may have uh some legal questions pertaining to that item and um I just wanted to alert you I may need to go in camera and also to see if uh someone from the legal department could contact illegal is here okay okay thank you councilor perks if I could still I'd still appreciate someone getting in touch with me okay you and someone get some we have some difficulty hearing you can you just repeat that could I I know you you know my cell phone number could you share that with someone with legal and have them get in touch with me please okay we'll do thank you okay um so item HL 16.2 Toronto Public Health 2025 operating budget submission and item HL 16.3 joint of Public Health 2025 to 2034 capital budget plan requests uh be considered together do I need a motion for that I think is The Bard is the board okay with that we this two items okay thank you okay no motions needed okay so we will now consider items that were held so items uh HL 16.1 update from the medical office of Health hiring committee so um I know there will be presentation on this item there are no registered speakers I think Phelps is going to come up and uh give us an update Jason you can introduce who you're with absolutely thank you thank you very and today so we do have a bit of a deck that uh we'll share here just to give some insight one moment okay excellent so as a brief update um we are well underway already on the recruitment uh for the new medical officer of Health uh we got out to Market uh within the last two weeks and we've already started having conversations with potential candidates and we've been doing a lot of Outreach so we're very much on track for our schedule as planned to get through our screening with the selection committee late September into early to mid October and we are on track uh to come back to the board uh later in the year with a recommendation so we've gone through over the last three weeks now I think fre uh about three weeks we've gone through a fairly extensive consultation we've had conversations with well over 20 individuals so far uh board members key stakehold holders across the city and partners as well as external stakeholders it's been a combination of one-on-one conversations and we have also been running a digital survey to receive feedback what we've got today is just an overview of the feedback that we have received and and this becomes the underpinning and that Foundation that we use on how we present the opportunity to potential candidates but this also feeds right into the selection committee and and the criteria the selection committee will be using as well to assess candidates as we get to the screening phase we'll Jump Right In we've got four slides and Fred and I will jump back and forth a bit here as well so starting off on the candidate profile you can see some of the skills and attributes obviously there are core aspects that are required for the medical officer of Health under legislation we have not outlined those factors here um the certainly requirement uh but in addition to that around skills and attributes you can see it's a fairly broad mix and current medical officer of Health certainly brings uh the majority of these skills so so big shoes to fill we're looking for an individual that can come in with a collaboration of the partnership building skills this is across the city across City departments and divisions but beyond the city as well to external Partners to healthc care sector to Community Partners to school boards to postsecondary it's a very broad mix of partnership and and we've come to realize just how much Public Health touches every area of our city uh we need an individual that has the Visionary skills uh that can look into the future and can help Public Health determine what is the direction and where is public health going and where do our priorities sit obviously the communication skills uh are critical and this would be communication of course to the board across tonal Public Health but that ability to communicate and work across uh a broad mix of stakeholders within the city and uh and and truly be able to again build the collaboration build the Partnerships crisis management as we know we've come through a fairly large crisis in the last number of years and the medical officer of Health uh certainly front and center so we need an individual that brings the calmness the adaptability the ability to navigate situations that are stressful um and and tense and and drive crisis as well the political acumine obviously the ability to navigate within the city within city council within the board but in addition to that other levels of government the ability again to build Partnerships and to navigate but be able to Advocate on behalf of Toronto Public Health to other levels of government that resilience I would tie this into that crisis management as well an individual that can handle the stress of of the demands of this position Equity inclusion diversity Equity inclusion core values for the city and and again a leader that truly lives these values and can continue to drive this as as core aspects for Tonto Public Health the cultural understanding of indigenous communities and the unique need sorry the unique Health needs as well associated with indigenous communities the leadership cultivation an individual that can cultivate leaders both with within Toronto Public Health but an individual that can cultivate leaders beyond the reach of the Public Health Board as well and finally that genuine authentic and truly evidencebased type of leader somebody that can use evidence to to uh communicate compelling uh Direction Advocate and and Drive Toronto Public Health forward so we'll go through the whole presentation before we open it up for questions and just touch on some of the challenges yeah thanks Jason so just continuing on and you might uh find that there is some overlap between Jason and and myself and the slides because it's while it's uh challenging to Define all of the roles and responsibility some of these things overlap so the fiscal constraints and budget we heard some some about some of that this morning uh where uh the city is being asked to deliver on provincially IM mandated programs with a fixed budget uh not not withstanding the challenges that the city might have in terms of of its own uh criteria and its own priority uh Public Health Emergency and infectious disease obviously uh Jason spoke to some of this we're seeing this more and more and we heard about that this morning again intergovernmental coordination the ability to work across government working with the federal government to a lesser extent but greater interaction between the provincial government but also the colleagues within the GTA and Beyond many of the public health challenges that we find in the 416 area is not confined by geography so the ability of that leader to be able to work across the GTA work between the provincial and the municipal government and also touch from time the time the federal government is an important uh issue uh the considerations around vulnerability with the population served by the city of Toronto um and we've mentioned here the socioeconomic ethnocultural and spatial inequities and this came out in many of the consultations we had a number of um your colleagues spoke about the challenges faced and and some of this was apparent during the covid-19 where there is clearly inequity in terms of health considerations across the the city of Toronto issues around me mental health and addictions the social determinance of Health became an important underpinning of this position so before it became a public health issue how does a city anticipate and plan for some of these challenges that might exist um down the road looking at maintaining and strengthening public trust and and I think we saw a great deal of that during Co 19 you had an authentic leader someone who the public trust to provide information to them um there is a uh a consideration that the city needs to sort of promote and strengthen that public trust that was gained and acquired during covid-19 so that when you bring evidence to bear on the conversation the public can have some confidence in what's being uh heard and that authenticity that Jason spoke about also I think is an important consideration here issues around anti-black racism and this was particular and it go beyond vulnerability that I spoke about earlier this and the health considerations within indigenous Community continues to be an issue that I think would challenge uh this um individual and the city as it deliberates on how to provide the best public health considerations across the uh the city dealing with other City departments and again uh while Public Health uh you know might seen as having a specific mandate the need to have this collaboration with other City departments is becoming increasing L important so what Transportation does for example or what Parks and Recreation does do have an impact on public health so the consideration here is that the public health officer needs to be engaged in some of these conversations at the ground floor so they can influence public policy when they're be made outside of pure Public Health considerations looking at building Partnerships is a very complex organization so how do you ensure that you build partnership uh with the not only the city departments but also City agencies and how do you leverage that to ensure that you have successful Health outcomes opio crisis was one issue that was mentioned specifically the shortage of primary care physicians I think is fairly self-evident and and self-explanatory looking at the health assessment of new Canadians and ability to do that early assessment to be able to address any uh emerging Public Health consideration that might be seen looking at Community engagement and I think this this goes beyond simply medical practitioners but looking at elders and others within the community who may have uh input into the public health considerations how do you engage a community how do you bring quote unquote stakeholders that are outside the traditional realm uh and how do you get that conversation going within the public health uh policy initiatives and then also moving forward with the ministry of Ministry of public Ministry of Health policies and interventions within the context of the budget and other considerations and the the issue here is not only about money but it's also about those unique public health challenges faced by the city of Toronto keep going on opportun on the Innovation on the opportunities piece obviously this there's lots of work to be done uh looking at Innovative health programs in an integrated way and the use of Technology was specifically mentioned how do we leverage that to ensure that uh we get the best outcome proactively addressing some of the systemic challenges and I spoke some of that earlier how do you leverage partnership uh tono is known for its Health Hub and a significant and Innovative and important health research that happens in the hospitals and other health health systems across uh the 416 and GTA area how do you leverage that and bring some of that to bear and considerations that the city of Toronto is contemplating through the public health portfolio um advocating uh this individual has to be a strong advocate for increased resources and funding for public health challenges looking at the uh integration of social determinant of health so getting ahead of the Corb as they say looking beyond the here and the now um and dealing with some of these systemic challenges evidence-based and data driven considerations while the political acument is an important consideration here uh the consensus view was that you need an individual who can come to the table with evidence and uh and data and the considerations being brought forward by the chief medical officer of Health has to be driven by evidence and by dat consideration building Public Health infrastructure to deal with considerations that might be forthcoming commitment to bold leadership I mean so this individual not only has to lead an organization consists of consisting of hundreds of of of people and millions of dollars of budget but also be someone that is is a Visionary someone who's inspiring someone who can motivate and Inspire their staff uh to do the kind of programs and policies and operations that is uh required by by those who live play and work in the city of Toronto the interdependence of building a healthy healthy City I mean Health Public Health consideration is just one of those things that has to be ju opposed against broader uh considerations across the uh City how do you do that and how do you ensure that those opportunities are are brought to bear and leveraging and building on past success I mean the city has had a really incredible successful run during covid-19 how do you consolidate how do you build how do you extend that public trust into those other areas where the city might be vulnerable or where people looking for for leadership and there is some reference to lactation clinics safe dining and travel vaccines which are opportunities to to uh Rebrand and strengthen that public trust that city has deserved deservedly achieved during the covid-19 uh crisis so as you can see it's a fairly long uh uh list of of items for the new medical officer Health to step into and and lots of challenges but lots of opportunities as well we'll wrap up with our final slide here just around future success and this question really comes to as we have our consultations looking at a year a year and a half give or take and what would the individual have achieved in that time to demonstrate success so here's collectively what we've heard I think the first two certainly tie together that execution around this newly minted strategic plan really driving the metrics and the oper operational components of that strategic plan now and and being able to articulate and clearly Define the public health priorities for the city get the support and get the Buy in across the leadership team and and the understanding across the city as well and the partners providing the support and continuing to enhance Partnerships we heard as we've talked about we've heard some great feedback from some of the general managers and other key Partners across the city about Toronto Public Health but the message was we have so much more we can continue to do we have a lot more opportuni still to strengthen these Partnerships using the data and really driving decisions based on that providing the adequate support in marginalized communities establishing priorities and guiding the Department's focus of course as well you'll see a lot of this is tying into that strategic plan execution the clearly defined metrics um and clearly Define priorities as well so that there's engagement of course driving and refreshing new policy initiatives and and revamps around that side especially as there's changes continually taking place at the provincial level that leadership engagement um the Toronto Public Health leadership team has come through a lot in the last few years and there hasn't been a pause so they've come out of the pandemic and there's an aspect here of continuing to find ways to engage to balance as well to balance the workload for the leadership team and find ways to give opportunities to have pause that refocus on core areas and again this is continuing to ensure that Toronto public health is focusing on the broad mandate the pandemic becomes all consuming and so as it continues as Toronto Public Health continues to shift uh and and recover I would say coming out of the pandemic is again focusing on the broad mandate and similar to Freed's Point earlier a few specific items that had come up through the success factors being the youth mental health framework and the healthy aging initiatives so we could uh we could drop screen at this point and open it up for any questions Cher Moy thank you for the presentation um if you um here we go you can see the members on screen any questions from the directors in the room online it just has a great job uh counselor Thompson go ahead thank you Mr chair and I do agree that they've done a great job I'm just wondering um where is the input from the outgoing medical offer of help how how have you consulted with her Yes actually great question and we just had a conversation late last week so that has been Incorporated we have a few updates still to do from the outgoing medical officer of Health but we have tried to reflect her comments in the broad mandate here as well and her feedback will also be feeding into the selection uh committees uh screening criteria as we get there and just final question um you've listed and you and um fre have listed a series of uh of of of uh elements I guess as part of the selection process what is uniquely different about this series of a list of things the competence competency communication and empathy and inclusion and so on what what's different about this list versus the previous list in which we hired for example Dr Dilla uh that's a great question now we don't have we weren't on the recruitment uh previously so I don't have the previous list I we would have to take that back uh counselor Thompson and and do a comparison to the previous criteria um I I don't have the previous criteria you would agree though that that would be at least important absolutely yes yes we will take that back and we'll work with the team to get the previous criteria and dig up what we we can from Tonto Public Health around that screening criteria and do a comparison absolutely sure thank you those are my questions Mr chair thank you both very much for your presentation okay thank you um director Roy do you have a question no any further questions yeah seeing none uh director uh o go ahead thank you so much for the important work that you all have done um just reading through the agenda and it says uh you you're working to prepare the job profile for the posting should I assume that the posting has already been done and you're currently screening so the uh the posting has been done yes and approved by the board um so the posting is live at this point we haven't got into our screening yet we're currently out to market right now so we're currently in the the phase of approaching potential candidates we've developed our research list so we're reaching out right now still peing interest we're in those early phases we will start to get into our screening later in September as we start to collect applications and receive interest yeah thank you seeing no further questions um I'll move a motion to adopt the presentation all those in favor opposed carried thank you the next item is item HL 16.2 uh Toronto Public Health 2025 uping budget submission and HL 16.3 Jo Public Health 2025 20 to 2034 capital budget and plan request I'll ask Dr Dilla to introduce the uh presenters Moy and good morning once again members of the board uh for those of you who are members of the budget committee you will be familiar with meline V my colleague who's just taking up her seat at the presenter's desk she is one of our managers and our operations and business services area and uh she in fact has uh done along with members of the team there the heavy lifting in respect of this year's 2025 operating budget submission from Toronto public health and as well the 2025 through 34 capital budget submission these submissions are of course part of the city's budget deliberation uh although we are uh a division that reports through a board similar to other City divisions we are um participant within the larger City process and uh we are subject to City timelines so in fact you will see our materials not only here but they will go through the city budget process as well again just a reminder to the reme to the members of the board who are not part of the budget committee uh this information was presented in large part to the budget committee on July 23rd just a few weeks ago as I mentioned in my opening remarks there have been some changes they are reflected here and meline will take you through them you'll see in our agenda that we've got uh the overall capital budget and plan request the 2025 operating budget submission and then a highlevel summary in respect of 2025 service levels which is part of the budget process just a reminder to everybody that the direction we did receive through the corporation was for a Net Zero budget given the particular Financial circumstances in which the city finds itself so with that I'm now going to turn it over to my colleague meline to take us through the presentation and thank you in advance meline thank you Dr Villa Dilla uh good morning everyone um thank you for the opportunity to present to you this morning the 2025 over operating budget and 20 uh and capital budget and plan submissions so uh next sorry no so let's start with the capital budget and plan so for the 2025 budget um request which is the first fiscal year of the 10year plan we are requesting a budget of just under 12 million uh at $3.9 million for four technology projects and one project for the dental program uh and for the total capital budget and plan which is the 10e time frame from 2025 to 203 before we are asking for $23.9 million next slide please so this slide will provide you in kind of the details of uh related to the project that we are uh requesting in our 2025 uh budget the first being the electronic medical records uh phase three this is to implement a new client information system um to provide a comprehensive uh electronic record of health related information for our our patients um to be used in our Toronto Public Health sexual health clinics and needle exchange clinics um the second one is a new project it's electronic medical record phase four uh this is to expand this new EMR solutions to the tuberculosis program this project is expect to be completed by 2027 the inspection management implementation so um to this project is to replace our current inspection man uh system which has um reached its end of life so um we are leveraging the uh corporate um customer relationship management uh tool called selfs Force to improve the efficiency and effectiveness of inspections investigation and enforcement um Service delivery the fourth uh project again this is a new project but it is a continuations of the inspection management uh system where we're going to expand this new uh inspection management to the rabies program uh this project is expect to be completed by 2026 um as I mentioned earlier we have one project uh in for the dental uh program um and this is to procure a new van for the municipal Dental uh program um this is largely to you know to reach um shelters and Community Service uh to serve um adults largely 18 to 64 years old um and some youth who are staying in shelters or some seniors uh adjunct to the long-term care home um the focus is really to bring uh care directly to the vulnerable uh populations um to have who who might not have access to Dental Care Program for a variety of reasons next slide please okay now let's talk about uh 2025 operating budget and what you see here is the continuity uh schedule uh that will provide you with what our approved budget was in previous year and what is the new um opening budget is that we are submitting uh putting forward for submission to the city budget process so back in February um the CD uh City approved our budget of a total of 278.15 gr expenditures and 77.7 in net expenditures and then from then uh from that numbers we kind of put in any in year adjustment uh first item being the increase in budget uh for uh the Healthy Babies healthy children program from the ministry of children and community and Social Services the increase is about 6.8% which translate to about um 1.3 million from April 2024 to March 202 25 um we also add back about 900,000 uh for the injectable opioid agonis treatment program um which we receive extension uh to March 2025 we also have a a change um in salaries and benefits of about 1.9 million this is to address the um inflation increase for our staff and also for uh the pay for performance for our non-union staff so that bring us to a uh restate the 2024 approved operating budget of 282.30 n.7 in net expenditures so then from this prated operating uh budget we then add in the incremental budget change for 2025 um as I alluded earlier um our IO program um we received expansion to March 2025 but as of right now there is no indication that we continue to receive the funding therefore you see an incremental reductions of about 1.1 in 2025 uh we also reflect determination of provincial funding for our um supervised consumption sit as of March 2025 uh and that's uh translate to an incremental reduction of 1.2 million in 2025 and then we also added the uh increased revenue from the Ministry of Health and dises to reflect the 1% in increase uh for our carare program uh for the from 2024 to 2026 um 400,000 of this 1.9 is applies to 2024 and the remaining 1.5 is for 2025 um and then we add also the increase in budget for the Healthy Babies healthy children program and this is the remaining 300,000 for the period from January to March um because the fiscal year of this program runs from April to March and then um the next item uh is all the salaries and benefits 1.6 million increment incremental increase uh this is mainly again related to the inational uh increase for our staff and also uh the pay for performance for our nonunion staff um we have an in increase of 886 th000 for our student nutrition program and this is really to address the year-over-year food cost of food increase of about 2.5% and also um a expected participation growth rate of about 2.2% year-over-year uh and then we have a um about 400,000 uh decrease in technical uh administrative and Technical adjustment and this is just uh mainly predicate around the decrease in interdivisional uh expenditures so that bring us to a 202 25 preliminary sorry uh preliminary um operating budget of 2828 million in Gross expenditures or 79.8 million in net expenditures so from a year-over-year perspective we are looking at um at this point in time an increase of 98,000 or 0.1% increase next slide please um so just quickly over uh the service level so for 2025 budget uh it's includes 63 service level uh 11 are new uh following the review that we uh have completed last year uh and 52 uh existing describing activities across um Toronto public health and so uh we have put the these new there's no change uh with the budget committee presentation um so but we did put it on presentation along with the existing so uh for your reference so that bring us to the end of the presentation thank you thank you mlin um we do have say thank you I had a laps in okay we have the deputation so mad if you take your seat and um I'll call the first deput Daniel freeit you're online yep I think you have five minutes Daniel go ahead okay great thank you I'm gonna I see there's a big speaker list I'll try to keep it fast and talk fast but slow me down if I'm going too fast um and I'm using my own stopwatch this time um many of you know me I've I've long been outspoken about uh certain Public Health measures um regarding Co in particular um but lately in other departments I'm seeing that sometimes government intervention uh has its own set of Health consequences uh detrimental Health consequences obviously beneficial as well for the most part um I saw this with uh the role of the covid vaccines and some of the restrictions on employment um some of the restrictions on assembly and the health impacts that had on various segments of the population um and I was hoping at some point various levels of government would start doing some self-reflection in the form of independent inquiries independent commissions it hasn't been done it's been funded now largely by civilian civilian groups with after tax money amazingly um the health consequence of in particular uh Co of vaccination uh resulted in set the setting up of the vaccine Federal vaccine injury Support Program last meeting I delegated requesting you know it was a long shot but that that this board set a budget for taking over responsibility for the vaccine injury Support Program um a colleague commented that was a long shot and kind of idealistic and I recognized that that was a bit uh perhaps too much of a long shot um in this budget doesn't doesn't address anything related to a self-reflection of the of the city's um response to covid and I think that self-reflection does need to be budgeted does it does need to be taken into account what went right what went wrong who was who was detrimentally affected was the response proportionate and getting accurate data getting accurate data has been an issue for various reasons um and I see by the way I see I saw a bunch of speakers were added to this this meeting starting from September 7th in the last two days I'm not sure if that was part of a coordinated response uh sometimes they form associations behind the scenes I think it was a pretty diverse group but at least with the previous um Board of Health meeting the the the noise uh people addressing the noise issues in the city came together and formed a very cohesive group to address the noise in this city and and you know kudos to them for mobilizing and getting the message across because I heard that I heard their message and I hear the noise now um point being vaccine injured folks tried to form Association and get together and make groups primarily online on Facebook but guess what those groups were destroyed that Association those associations were were devastated um they were accused of spreading misinformation even amongst private private groups amazingly um there's been a couple of other groups that tried to pitch in and help take action Canada that started collecting names of people um third parties that were IND that were harmed by the vaccine again I haven't I don't know for a fact that you know the extent of the injuries in all these cases I do know that the vaccine injury support program is going through a backlog of vaccine injuries um and I know that there was a a Freedom of Information Act request asking for details of the of the adverse event following immunization uh heal Canada couldn't get back to them because there's too much there's millions of pages apparently um so they have to refine now the searches unlike to this person this is again after tax money why who's paying for all these searches like this should not be on the public now or these loan groups to fund this stuff there should be something tackled by the Board of Health um I don't want to use my five minutes I want the other folks to talk but you guys never asked me questions so I want to take 30 seconds to ask myself questions um Mr fright we have situations here where uh a number of us including the medical officer of Health made these recommendations that are now going to potentially um you know create an awkward situation how do we address that either conflicts or well it's a good question I think what you have to do is uh look outside the board look out look at hiring someone and again I'm not this isn't a pitch for for my Independence because I have my own perspective on this um although I do consider myself quite independent for the most part um it's time to find that this board sets aside a budget for self-reflection in the form of an independent counselor therapist or you know like kind of group therapist for the board and say what did we do right what did we do wrong who's been harmed and how could we make this better um I do have 45 seconds if you want to ask any questions but otherwise get on with the other speakers thank you so much uh thank you any questions for the deput seeing none thank you for coming in today uh next uh deput is Jillian Evans from Mark Gro colle Collegiate Institute are you here online okay hi I'm here there we go turn on my video okay uh thank you thank you uh chair and to the Board of Health for listening to my deputation this morning in support of increased funding to schools for student nutrition programs my name is Jillian Evans I'm the principal of Mark garau Collegiate Institute we're a high school in the thorn cliff and Flemington Park neighborhoods and home to over 1,800 students making us the third largest High School in the Toronto District School Board and I'm coming to State the obvious that everyone on this call knows that countless studies and Publications have reinforced our understanding when students in schools have something to eat they're more likely to be able to focus and experience success here at Mar arau we're the recipients of some of the largest nut funding grants in the city we serve as two of the city's highest priority neighborhoods home to more than 7,000 schoolage children most to who have arrived in this country within the last 5 years we have an annual Grant of approximately $160,000 that gives us the ability to provide 100 hot breakfasts 200 hot lunches and 1,000 healthy grab and go snacks per day but we can't do it on our funding Grant alone we highly subsidize through fundraising we grow grow most of our own vegetables with the support of community volunteers and as a result we're able to reduce the cost of fresh produce while increasing access for students we maximize the power of the bean and the lentils giving students high protein inexpensive meals that are reflective of their cultures mostly because our modest budget allows us to serve meat only once per week if we're lucky but if you do the math you'll easily calculate that our $160,000 annual Grant allows for approximately 80 cents per student student per day so I want you to take a moment think about what you could make and pack for your lunches for 80 cents per day student size carton of milk is 90 cents whole bananas close to a dollar we can't give kids what they need to learn on the existing grants and even with our active fundraising growing our own food and dipping into my very modest school budget we don't have enough we know that on April 1st 2024 the federal government announced the new National School food program investing a billion dollars over five years the money's been promised and my ask is to start to see the money where it's needed here in the schools thank you thank you very much any questions for principal seeing none thank you for coming in today um Sarah Watson North York Harvest Food Bank are you here good morning yeah have 5 minutes food bank and I am here to speak in favor of increased funding for the student nutrition program North York Harvest is the primary food bank for Northern Toronto our catchman stretches from Steels in the north to Eglington in the south from Highway 27 in the west all the way over to Victoria Park in the East that's nearly a third of the geography of the city we have been providing emergency food support to community members in these areas for nearly 30 years but never have we seen the level of demand that we and our partners have been faced with over the last several years in July of 2019 we saw roughly 13,000 visits to our programs 13 this past July we saw nearly 30,000 and of that 30,000 27% of those were children and youth more than one in four 18 % were 12 or younger we also see every day that poverty and food insecurity does not impact all people equally racialized communities in particular black Latin American Middle Eastern and Indigenous community members and their children are all vastly over represented in our programs and newcomers to Canada those who have come here with the promise of opportunity for themselves and their children we ALS also see at vastly disproportionate rates last year is part of the annual who's hungry survey that we cond conduct each year in partnership with our colleagues at the Daily Bread Food Bank 16% of parents said their child had gone hungry at least once a week or more in the last three months that was up from 12% just the year before and we know that that comes as a last resort to families who will do everything in their power including skipping meals themselves so that their children can eat no child anywhere but especially in a country as resourced and Wealthy as Canada should a child ever go hungry the impacts of food insecurity and hunger on children are far-reaching and have a profound effect on their health and well-being but also on their ability to learn a child who goes to school hungry cannot be expected to learn or to focus it's our understanding that last year there were 21 additional schools eligible for funding but lack of budget meant they could not be added and that many existing programs are struggling to provide adequate food to students with their current funding and all of this at a time when our city is facing a level of crisis in terms of poverty and food insecurity that North York Harvest has not witnessed in our 30-year history we have never seen the level of demand for emergency food support that we are facing right now and quite frankly it is unsustainable Food Bank programs will and have collapsed under the pressure we are currently facing we cannot move forward like this as an organization or as a city North York harvis strongly supports the Board of Health reiterate its request that the government of Canada expand the national food program School food program to provide funding for a universal student nutrition program and that the province of Ontario increase its investment to match that of the city of Toronto and to address the inflationary cost of food food banks in the charitable sector alone cannot and should not carry the weight of this crisis all levels of government must work together to ensure that all of our children have access to the food and nutrition they need to grow learn and reach their full potential a fully funded Universal free school nutrition program would go a long way to helping us reach that goal thank you my mic is not on any questions for the deput see none thank you for coming in today um Melissa Wong social planning Toronto good morning yeah 5 minutes hello thank you chair and members of the board Board of Health for the opportunity to address you about address you about the Toronto Public Health 2025 operating budget submission my name is Melissa Wong I'm the director of Engagement and strategic initiatives at Social planning Toronto we are a nonprofit charitable Community organization that works to improve Equity social and economic Justice in our efforts to address policy and systems change we collaborate with with over 150 community-based and Grassroots organizations that collectively represent tens of thousands of economically and socially marginalized residents across the city I'm here today to voice social planning Toronto's support for the board of health committee recommendations to increase student nutrition program funding for many years social planning Toronto was tracked reported and organized to advance Solutions and Investments that will reduce the impacts of poverty in our city we know from the most recently available data on and family poverty that there are almost 97,000 children's in children in Toronto living in low-income households that means a child and P family poverty rate of more than 20% an increase of almost 4% between 2020 and 2021 so the increase in student nutrition funding is needed now more than ever in the past year we were working with a group of Community Partners to identify policy solutions that could help those who are struggling to respond to the rapidly increasing rates of food in security the number one recommendation was to increase long-term and flexible funding for food security including automatic inflationary increases to the student nutrition program to cover Rising food costs and making breakfast and lunch programs universally available in all publicly funded schools in Toronto we are a long way from having universally available student nutrition programming in the midst of growing need according to Toronto public Health's own reports of the own reports of approximately 855 public schools in Toronto across the four Public School boards there are still 235 that do not have a student nutrition program the staff report on 2024 student nutrition program service subsidies indicate that despite requests for new programs and increased demand there's not enough funding to approve new programs for existing programs the ongoing Reliance on school communities parents and volunteers to fund raise and deliver these programs is unsustainable and inequitable as a parent myself I've seen the disparity between school communities who are able to subsidize and fund raise for their student student nutrition programs and schools who do not have this capacity not surprisingly schools and higher need communities often end up with programs that run out of funding during the school year while some programs are forced to reduce the amount of food that's offered to children or the number of days that they run their programs more often than these are communities in high higher racialized populations including black indigenous and newcomer populations despite living in the wealthiest city in Canada the sad reality is that many children in our schools are going to school hungry every day and we and our governments are failing them every year Toronto City Council has approved increased funding for the student nutrition program but as inflation rapidly increases and demand grows this funding is insufficient to meet the rising demand of our school communities Ontario has provided one-time funding increases and the federal government has announced a national school food program but the money isn't flowing fast enough and it's not enough to keep up and feed our children the Board of Health budget committee made four crucial recommendations to address this growing crisis which includes increasing the municipal contribution to 20% calling on the government Canada to F fund a Universal Nutrition meal program for every school-aged child calling on the province of Ontario to increase its funding for the student nut nutrition program to match Toronto's investment and fund inflationary food costs and to work with the provincial Pro provincial and federal governments to expedite Toronto's share of the 79 million promised for student nutrition this year social planning Toronto strongly supports these recommendations we need all levels of government to step up this is why we urge you the Board of Health the mayor and members of city council to do everything in your power to hold the other levels of government accountable to their duty to the children of tono I would also like to speak briefly to the closure of the safe consumption sites and the end to needle exchange programs safe consumption sites are proven life-saving program and should be continued as part of a full spectrum of services for people who use drugs moreover needle exchange programs have been around since the 1980s as a necessary measure to prevent the spread of disease ending these programs is irresponsible and counter to Public Health principles I urge the Board of Health and city council to continue funding these Serv services and work with the province on of Ontario to Halt the closure of these Services thank you for your time and consideration uh thank you Melissa any questions for the deputat uh seeing none thank you so much for coming in today um Susan Wright summer lunch plus are you here online okay Susan here we go you have five minutes hi uh hello my name is Susan Ry and I'm the founder of Summer lunch plus our goal is to bridge the gap when school food programs are on break during the summer months and I would like to thank you all for increasing the investment in student nutrition in the last budget and I would like to shout out Deputy Mayor Morley for working with me to expand the city's definition of student nutrition to include summer as a critical wind of support for children we just wrapped up our ninth summer of running our food literacy and cooking skills program this year we had the opportunity to reach even more children and their families in thorncliff park we continue to deepen our support in Alexander park and we are very pleased to share that we ran programs in Ottawa and Orangeville for the first time it's an opportunity for us to practice scaling in communities outside of our longstanding Toronto partner neighborhoods while packing meal kits in Thorncliffe Park this summer I heard from many families but one story has stayed with me a mom approached me she caught my arm and was worried that she was I was worried that she was unhappy somehow because she seemed agitated and had a sense of urgency about her she said I'm so glad to meet you I have to tell you about your program I've been here in Canada for six months I'm from Morocco and I was very concerned about your recipe for couscous because it's not the way we make it at home but I encouraged my daughter to make it anyway because our program is a cooking program for kids we loved it so much we sat on our floor of our living room and dished out 11 servings in plastic cups so we could share with our new neighbors we hadn't met them before and this felt like a reason to introduce ourselves now we share food with our neighbors most weeks and they share with us too you helped me and my daughter create community Through food and it feels less lonely now the rising cost of food and the corresponding increase in Ultra processed food consumption makes it critical to ensure families can access nutritious food year round this is not just about feeding children it's about Empowering Families with skills and knowledge to shop and cook affordably while supporting Stu School nutrition programs is vital I urge the city of Toronto to take the next step invest in a pilot program that extends support through summer during the summer Mo months Food Bank usage spikes and families struggle with the safety net that school food programs provide I've spoken with Sahar a fellow Advocate from The Daily Bread food bank and we both agree that children deserve more than their basic needs they deserve a holistic robust program that not only addresses food security but also offers essential life skills social connection and food literacy over the summer when they're missing that necessary support that school provides today I asked the city of Toronto for two things one establish a dedicated summer food budget for 202 five allowing organizations like mine Sumer L plus to scale and meet the growing needs in our city and two I would welcome the opportunity to collaborate with those developing food Security Solutions to share more more about our proven program which has demonstrated positive impacts on shopping habits cooking skills increased consumption of fruits and vegetables and more thank you for holding these consultations and listening to folks like me who feel strongly about growing healthy kids who will grow up to be healthy adults in the city of Toronto thanks uh thank you Susan any questions for the depent seeing none thank you for coming in today I love cuscus by the way um Omar Khan engaged communities good morning there we go five minutes yeah okay hi everyone uh I'm Omar Khan I'm the coordinator of a Grassroots group called engaged communities that works in thorncliff and Flemington and uh along with York University and tno we studied the local experience of food insecurity from 2021 to 2023 which is of course directly connected to the student nutrition program so when we spoke with local parents uh the majority of them knew comers about food insecurity they listed all the connected challenges I I want you to listen uh to this parent talk about her struggles when she thinks about putting food on the table oh can you guys I can't hear this hold on let me see technical difficulties Tech's coming sorry Tech is behind you there oh yeah sure check audio give me a second yeah sure I pause your time you can just tell us what she says okay we're tied on time today e so uh so our research made clear that the student nut nutrition program won't get to the heart of food insecurity issues uh which is of course poverty but it can still help families by feeding their kids on school days uh and so research shows that children who consistently have a healthy meal in the morning are more engaged in the classroom have better learning outcomes show better problem solving skills and have healthier relationships um Studies have also shown that the school food programs can contribute to lifetime of healthier eating habits reducing the risk of chronic disease later in life and and so the huge return on investment in student nutrition programs is realized over the course of each child and that's why almost every oecd country has a national student program uh nutrition program but but not Canada and you know in Canada about one-third of students in elementary schools and twoth thirds of students in secondary schools do not eat a nutritious breakfast before school and those percentages here in Toronto are even higher so uh so this is what I see on the budget submission today so it's an 886 th000 increase to the student nutrition program to cover inflationary costs um so this gets I gets us to 17.4% uh not the 20% uh of the student nutrition budget that the board recommended in July um so just frankly this is not not enough um like look at these Toronto Food Bank visit numbers like Skyrocket in 2023 and we've heard it's Skyrocket and even more so in low-income communities where I work uh the demand has grown even more one thing I really want us to think about is that the residents told us Frontline workers to consider the ways in which we are part of the system that maintains food insecurity for certain individuals uh and I think the Board of Health should really think about that if the Board of Health is not meeting its own student nutrition goals and it's not knock down the doors of the province and the FEDS then we're not helping torontonians most in need we're just turning our heads away while we hope that the food bank bandage can do something that they've acknowledged they can't uh so so what is needed um first funding obviously the Board of Health and the mayor need to be finding every opportunity to engage the feds in the province it is terrible that the federal money is not flowing as this school year has already started and it's a shame on the province uh for not helping either um but money isn't enough something is broken with how we're doing the student nutrition if we have schools in dire need and and I know some of those schools that have no student nutrition program our goal should be a universal program and the current model is just not going to get us there um finally of course uh the board and the city more generally uh need to work on the core challenge which is poverty and affordability uh so thank you to the board for considering these needs these are our research Partners uh and if you want to learn more uh there this the food report is there and have submitted this to the to the board thanks uh thank you Omar uh any questions for the deput give me a second for I any questions for the deput seeing none thank you for coming in today uh Dr Dan WB director Center on drug policy evaluation semic Hospital you're online drb you have there go ahead thank you so much for having me uh I'm uh the director of the center on drug policy evaluation at St Michaels hospital and I'm also the chair in mental health and substance use disorders at St Michaels Hospital in the University of Toronto so uh I want to talk uh today about um the impact of supervised consumption sites on the death of people who use drugs in ton and I'll start with a question what would you say if there were an intervention that could reduce death among Toronto's most marginalized communities by 2third across entire neighborhoods in the midst of an overdose crisis that has claimed more lives in this province than covid-19 this would be an incredibly cut and dry situation if we were talking about anything other than the incredibly stigmatized uh uh behaviors surrounding substance use so I I just want to share my screen and elaborate a little bit oh uh it looks like I need to be made a presenter okay thank you is a to share your screen okay can you see that y so earlier this year we published uh a paper in the lanet public health the world's leading Public Health Journal we worked closely with the Ontario Chief coroner's office and analyzed overdose mortality across the city of Toronto and uh this work led by indu ramahan a brilliant young scholar demonstrated that neighborhoods in which supervised consumption sites were implemented experienced a 2third reduction in overdose mortality this reduction was not only experienced very very close to the sites within 250 m not only within 500 M but there was a two thir reduction in overdose mortality as far as a kilometer away we saw similar reductions two and a half kilometers away from these sites and within five kilometers even um and all of these are statistically significant reductions we did not see similar reductions in neighborhoods in which sites were not opened furthermore this is a little bit harder to see but I'll just note that the longer the sites were opened year over a year the stronger the protective effect of these sites were against overdose mortality across neighborhoods in the face of this evidence which is just one piece of the growing and quite large evidence that has led to a scientific and medical consensus that supervised consumption sites are among the best uh interventions we have to prevent overdose mortality given this consensus given that we what we know happen has happened here in the city of Toronto in terms of Overdose mortality reduction it is absolutely unconscionable that we are facing the closure of these sites and I Call On The Board to ensure that the works remains funded and to work with the other sites that are facing closures and budget cuts to ensure that they remain open thank you thank you Council perks has a question for you go ahead thank you for that Dan that's very powerful and and um I'm going to be getting in touch with you to get that data some people in the conversation have made the argument that you can simply substitute uh other services that are not harm reduction based and get the same outcome do you agree with that or do you challenge that I I I fundamentally disagree and I'll just say that first of all I've submitted this paper to the board so you should all have a copy of it um the only reason that we're talking about a harm reduction versus treatment binary is because governments have been unwilling to fund a comprehensive system there is nothing in the scientific or medical literature to suggest that harm reduction and treatment are in competition this is a this is a fictitious political dichotomy um the fact is that harm reduction is the single most effective to con most effective way to connect with people who have the greatest need for treatment and not only the closure of the supervised consumption sites but the uh restrictions around the supplies of harm reduction materials that will accompany these hard hubs really makes it difficult to understand how and why people would be uh connecting with these sites and communities if they can't provide them with life-saving uh interventions like a medically supervised place to inject and materials like sterile syringes that can ensure that they don't die of infectious diseases like hepatitis C and HIV I you know I've likened this to the idea that you're building this big gleaming hospital state-of-the-art hospital and you don't add doors right like this this is a an incredible investment this is an investment that should have happened years and years ago and I'm talking about the the 380 or so million dollars in in treatment that the Ford government announced but there's no reason that this should be decoupled from uh harm reduction at best the closure of these sites will really reduce the effectiveness of this investment and at worst it will absolutely undermine the progress that we've made and like it it is very difficult to call it progress but we know for a fact that people have remained alive because of super rised consumption sites and the work that I and others have done have shown that this is linked directly to um the the implementation of harm reduction Services here in Toronto and elsewhere you know at worst we will see an increase in the number of torontonians who die of preventable deaths and again you know we have had more people since this uh fenal driven overdose crisis has started in around 2017 in the province that have died compared to co we didn't know what was killing people with Co and we were able to save more lives than we've Let Die of uh a condition that is entirely preventable so Dan Ju Just I think I heard two things and I'm just gonna ask if if if I'm heard correct you're saying first that treatment does not replace harm reduction in terms of saving lives and secondly that the two together are the best outcome absolutely I I don't think that there's any Advocate out there any any uh Observer scientific or otherwise that suggests that it's an either or you know and there are ways that uh treatment can help of course stabilize people can uh you know opioid Agonist therapy is the most effective solution that we've got to help people manage opioid Ed dependence it's on who's list of essential medicines for uh exactly that reason um but treatment in and of itself does not get people through the door you need to get people through the door and you need to keep people alive so that they can access treatment thank you very much Dan uh thank thank you I have a question so you work in a hospital setting um how will the imulation of uh SCS impact the strains on your department or the hospital in general there's a number of different strains that that it will impact so first of all you know absolutely emergency department uh volumes will increase at St Michael's Hospital where I live or where I live I practically live there um where I work um you know we already are have an emergency department that has the highest proportion of people who are presenting with substance use related uh conditions and that is just going to increase as the various sites across the city are closed and the sites that remain are overburdened uh and uh you know are are not provided with additional budget to uh manage the the additional clients that they see so in the emergency department absolutely we'll also you know see uh KnockOn effects across departments with likely increases in the the presentation of people with hepatitis C infection with HIV infection uh with endocarditis uh you know which is basically an infection of the blood um uh which is incredibly uh complex and uh costly to treat um and you know all of this is preventable I I'll also say that there are KnockOn effects for public health generally um Public Health has been Toronto Public Health has been a strong partner in uh Toronto's drug teching service which provides voluntary uh highly uh detailed analysis of the contents of unknown drug samples for people uh who need that and Toronto this has been a key data source to inform Toronto Public Health um rapid uh alerts uh that um can provide communities across Toronto and in fact the GTA and Southern Ontario with information about um specific drugs that are circulating that can result in Greater overdose risk or more complex overdose presentations the drug taking service um operates you know is it effectively operates out of supervised consumption sites in the city of Toronto and if those close it will detrimentally affect the capacity of Toronto Public Health to not only serve people who use drugs um who are you know at Great risk of Overdose but serve entire communities who uh desperately need information about what's circulating in the drug market and you know it's not only um people in the public health sector that includes law enforcement uh that includes uh public policy makers and um you know the Ripple effects are very very detrimental thank you for that uh any other questions the deput I see none thank you again uh on the list uh Dane Kent manager region Park Health Center are you here here you are go ahead you have five minutes good morning members of the Board of Health and fellow community members my name is danne Kent I'm the manager of the consumption and treatment service at bevel up which is located within the region Park Community Health Center I'd like to say that we are standing on the brink of a public health disaster across Ontario the provincial government's decision to defund 10 sites across the province five of which are within the city of Toronto well have catastrophic consequences for communities across the province this isn't just a policy decision it's a decision that will cost lives and its effects will Ripple far beyond the cities where these sites are located every two and a half hours someone in Ontario dies from the toxic drug Supply these are entirely preventable deaths and they're happening because we are failing to provide the support to the people when they need it supervised injection sites are on the front line of this fight these are not merely places where people use drugs there are facilities where lives are saved where people can access life-saving care and be connected to the supports and the broader systems that they need in the past three years 9,300 overdoses have been reversed in these sites that's 3,100 lives saved per year if these sites close these overdoses will not simply disappear since 2018 391,000 injections have occurred Within Toronto alone they will happen in Alleyways parks and public restrooms across Ontario and the people affected will not have access to the critical life-saving interventions that they need without these sites paramedics will be tied up responding to an additional 9.5 overdoses per day adding 6,935 hours per year to their workload that's the equivalent of more than three full-time paric positions an unsustainable burden on our already strained Emergency Services what happen happens when emergency services are flooded with overdose calls what happens when our First Responders can no longer keep up will we see ambulances backed up at emergency rooms leaving the rest of the city unprotected people who could have been saved will die waiting the very system designed to protect us will collapse under the weight of this new decision Emergency Services across Ontario paramedics firefighters and police will feel the strain when overdose calls flood 911 dispatch ambulances will be tied up hospitals will be overwhelmed and our First Responders won't be able to keep up this isn't just a health care crisis it's a public safety crisis and it will affect every Community rural and urban in our Province without these sites the 6,200 ambulance hours saved every year by on-site overdose reversals will be lost creating delays in response times and risking more lives we need immediate action first we must launch a provincewide advocacy campaign to demand the provincial government reverse this Reckless dis ision from Toronto to Thunder Bay from Windsor to Ottawa communities need to unite and make it clear we will not stand by while these lifesaving services are taken from us second I call on the leadership of our Emergency Services police fire and paramedics across Ontario to stand up and speak out they know what this will mean for Public Safety and their voices are crucial in demonstrating the true gravity of this crisis third we need to appeal to the federal government for support harm reduction is a national issue and when provincial policies put lives at risk the federal government must step in fourth municipalities across Ontario must explore alternative funding sources to keep these sites open in the short term we cannot let the sites close while we fight for permanent Solutions we owe it to our communities to keep this essential Public Health infrastructure intact finally the provincial government must recognize that we are in the midst of an opioid crisis and declare a public health emergency this is not just an urban problem it's a provincial problem deare declaring an emergency will send a strong message that we will not accept more lives being lost to these decisions the cost of this decision will be paid in lives the lives that we would have saved at our site and the lives of mothers and fathers brothers and sisters and children that ontarians will watch drift away while frantically looking for the ambulance that they've called but they can't hear the sirens for in closing these injection sites are not just about harm reduction they're about saving lives and protecting communities in the last three years they've reversed thousands of overdoses prevented countless deaths and eased the burden on Emergency Services they are essential to Public Health infrastructure in Ontario and we must fight to keep them open thank you uh thank you uh Council perks go ahead five minutes muted you can't hear you councel perks sorry about um thank you for that deputation that was really powerful you've made a suggestion that uh a certain number of our ambulance hours would would need to be you know it would be impacted how do you come to that figure so the average amount of time that an ambulance is tied up on an overdose call is roughly two hours that includes the time to get to the call the time at the call the time from the location of the call transport to the hospital and then generally the longest amount of time is the wait for the transfer of care within the emergency departments so if we look at the amount of ambulances which the Ontario ambulance Chiefs like paramedic Chiefs of Ontario suggest that there's 830 ambulances within the province and we're seeing um you know if we if we say N9 and a half overdoses per day at two hours per overdose take that with uh the amount of ambulances available and that's how many hours you would get you would generate each year in terms of having that would be added to the system right there's already 14,000 overdose calls dealt with by paramedics every year and we're adding 9,000 to that so almost doubling it wow okay thank you thank you uh I do have one question do you have any stats for your clinic um in a month's period like how how many clients do you see how many overdose take place there perhaps oh I have plenty of stats for my site um so bevel up sees about 10,000 people a year um of that 10,000 about 800 are Unique Individuals um our site becomes cost neutral to the downstream Healthcare System if we prevent heeps C Transmission in less than 1% of our injections um we see about 150 overdoses per year at our site um and of the 800 people that access our site every year we have over 1,500 Unique Individuals referred to secondary supports which means that each person accessing our program is also connecting to two other programs within the context of our integrated ground floor model great thank you for that appreciate it see no other questions um next up Marina Classen Toronto overdose prevention Society are you here online okay hello everyone thank you so much for having me this morning um good morning Board of Health thank you for the opportunity to speak with you this morning about the 2025 operational budget um my name is Marina Clawson I'm a Frontline harm reduction social worker I have worked in this field for the past 10 years I'm here to speak to you about the need for an increased Municipal funding to protect and keep operational life-saving harm reduction services in our city and the need for the board to protect and speak up to the health rights and safety of torona citizens the majority of my career has been under the heavy shadow of a Public Health crisis the toxic drug poisoning crisis it's been like living through a war I've lost countless clients colleagues friends and Community overdose does not discriminate it impacts communities in every demographic of our city I don't need to tell you that it's become one of the leading causes of death for Ontario citizens under 65 one person dies every 2 .5 hours in Ontario even with existing overdose Prevention Services we have in place at this moment that means in the course of just this meeting this morning we have lost another precious human life These are friends children siblings parents and loved ones I don't need to remind the members here that the closure of sc's across the city will be a death sentence we know as experts in our field that this will result in Mass death increased transmission of heepsy and HIV and add incredible burden on the healthcare and emergency responses systems as Dane pointed out today they are already crumbling services and despite what Ford's government says this will decrease Public Safety by pushing substance use and overdoses into the streets traumatizing bystanders who are unprepared to respond respond when you close supervised consumption sites your whole city becomes an unsupervised consumption site in Toronto sces is alone nearly 11,000 overdoses were reversed just between 2020 and 2024 that's 22,000 reversals in sc's across Ontario there has never been a single death in an sces we know they are simple essential evidence-based services that keep people alive and connect people to supports taking away one key intervention and restricting the freedom of municipalities to implement the solutions that their communities need and have invested in for years is impr practical unfair and irresponsible so Ford's decision to shut down these Services means Toronto communities have less tools available to support themselves and would be at a net loss SCS has already provideed the services that the new heartless hubs model is proposing to deliver plus offering life-saving overdose prevention this investment is not an equivalent replacement of care so investment in housing which is really what this proposal is actually talking about not an equivalent treat they're not actually promising treatment services and they're not actually promising beds treatment beds or oat or detox beds they're just talking about housing so we're not creating equivalency of harm reduction services and life saving plans we have an Ontario Healthcare Act for a reason so that our Healthcare doesn't become a political tool to be played with at the expense of our well-being and lives so Ford's actions to close SS is flies in the face of all of our protected rights for health I think that your responsibility as a board of health is to ensure the public health and program services are delivered to the city in response to the need so your role is to reduce inequalities to create accessibility and to improve the health of the city and the city population so we need your leadership more than ever your voices matter so much we need you to stand up to the Ford government advocate for our most vulnerable in our communities and if necessary we need you to find funding within your operational budget to keep safe consumption services and harm reduction Services open in the five Toronto sites slated for closure if the province decides to recklessly proceed with the defunding so we need your leadership now more than ever to protect Toronto citizens from the Ford's conservative authoritarian decision to deny evidence-based life-saving Healthcare lastly I want to Echo the call to declare a Public Health crisis please name this C crisis for what it is challenge The Province to not only words but also in actions and find the funding to keep sc's open thank you very much uh thank you any questions for the deput see thank you Melissa for coming in today Marina sorry uh Serena biry board chair friends of Kingston Kensington Market okay you have five minutes go ahead shair of friends of Kensington Market a not for-profit Community organization I'm also a PhD candidate in health policy and Health Services Research at the University of Toronto and I'm here to oppose the closure of Overdose prevention sites including the Kensington Market overdose prevention site came offs my former PhD thesis supervisor prior to his well-deserved retirement Dr Greg Marshon perhaps best known for his work on the Romo report would speak to incoming policy students and each year he started with one piece of advice remember our work is not bloodless he said that to remind us that as health policy experts and the people affected uh and the people affected by policy um decisions that there are many layers of in uh insulation between and I pass that caution on to you in this insulated room in City Hall policy and budgetary decisions can be violent when they cause real injury and death and that is something that must be taken with M utmost seriousness the recent provincial 2025 budget submission and medical officer of Health recommendations before you today present serious policy issues that are repetitions of decisions that were objective failure these include failures in timeline in evaluations of cost Effectiveness and in justification through Community safety the most glaring failure is a mismatch between the closure of effective overdose prevention uh sites and the potential opening of proposed heart hubs we have seen this happen before with the closure of mental health institutions in the early 90s this Common Sense Revolution later called the war on the poor and the current and the current provincial government seems set not just on repeating it but amplifying it Community treatment orders were offered up as the solution but with no bare minimum policy floor governments were not required to ensure that adequate resources were in place to implement CTO adequately or in the timely manner and instead what we saw is what experts at the time described as Mass transinstitutionalization from hospitals to streets and prisons we are still paying the price for that failure today as I've said multiple times witness witnessing policy failures throughout the recent pandemic we have to learn from this and do better not worse the recommendation before you would result in the closure of existing Ops sites by March 31st 2025 while the heart hubs are vaguely planned to begin operations in Winter 2025 that is the kind of Gap that people fall through today's decision is being made before the heart Hub application deadline even closes in October there is neither enough evidence that heart hubs will prove effective at all let alone more effective or any reasoning provided as to why this large gap in services in service timeline exists we don't have detailed information about what these hubs will look like in order to responsibly make a decision right now and this service Gap will inevitably lead in itself to loss of life while services are unavailable this leads to a question of cost Effectiveness one thing that I think is not discussed enough in Health Systems is the inefficiency caused by dismantling existing programs that work we know that our Ops sites work and that took a lot to establish they took time training trust building with the precarious populations they serve we know that they are operating effectively now and it will cost us considerably more as taxpayers in public health safety and mortality and in health professional fatigue without these Services we will pay astronomically more by addressing these patients with the only tools we'll have left hospital emergency rooms overburdened emergency services and prisons we will predictably see unsupervised substance uh consumption and increased preventable overdose mortality as other deputat have spoken to this brings me to community safety I live in Kensington markets strange and wonderful Alleyways and I have lived there for over 20 years before and after the opening of kops the overdose prevention site in 2019 I can tell you with certainty that I know where people will go when they don't have access to Safe injection sites I have also spent the last week speaking to neighbors both residential and Commercial who shared fears that this will mean more substance use in parks and Alleyways and public bathrooms and I can speak from experience in saying that there is nothing safe about finding someone experiencing an overdose or Worth or Worse already dead on your doorstep do not use Community safety in our name to justify this catastrophic decision I urge you to learn from the intelligent deput who spoke spoke today and the policy failures of the past and stand for evidence-based responsible and compassionate models of care in the 2023 chief medical officer of Health Report Dr Kieran Moore recommended increased access to Safe injection sites do not allow the closure of kops and other safe injection sites and certainly not without a viable and established alternative you may never know the people affected by your decisions today but we know their names and faces in Kensington Market I know future policy Scholars will be looking at transcripts from decision of decisions made here today and your names will be part of our history and future know that your work here today is not bloodless thank you yeah thank you um any questions to the deput uh seeing I do have one question just to for clarification um in regards to hard hubs do you see them as part of Continuum of Care in addition to harm reduction and uh safe consumption sites it was difficult um even as a person that's fairly experienced with reading policy documents to get a clear sense of what was actually going to be established um and as I mentioned with the timeline it would already be an unsafe transition if there is a way to actually invest more without doing the dismantling work that's being proposed I think it would be both safer for communities and it would repres represent an actual expansion of care right now what's being proposed is vague it's too far off from the proposed closures and we don't have enough details to even make a decision as an informed public okay thank you uh next on my list is Ola Saka who I have one question oh sorry go ahead councelor perks I didn't see you that's okay thank you very much for your deputation I just want to make sure we clearly understand the the best system is one that has both uh very strong harm reduction uh safe consumption services and has housing and treatment supports as well not either or but both yes but we didn't actually see any proposals to build maybe I missed it but I didn't see any proposals to actually build more housing in this so I'm not asking if I'm not asking if the provincial Pro proposal is right I'm asking the the best model is uh harm reduction Services treatment services and housing supports absolutely if they do actually come together but it's not clear where that's actually coming from at this point okay thank you thank you and pleas Ola please help me pronounce your name properly SC delara Leslieville home reduction coalition online I think I saw you earlier sorry about that hello you help connected Can you help me pronounce your name properly H Olas SCA you are correct thank you five minutes go ahead thank you so much hello my name is Olas scasa I am here today as a social worker a har reductionist a neighbor and the founder of Leslieville har reduction Coalition today I want to address HL 16.2 recommendations 1.a and 1.8 which concern the decrease to the budgets of the injection opioid Agonist treatment program and the supervised consumption site due to the end of federal and provinal funding for these programs these Services must continue and the city must provide the funding needed I want to emphasize the importance of e the municipal level of providing evidence-based Compassionate Care for people who use supervised consumption sites and who use injectable opioid Agonist treatment as a social worker and public health professional I know that these interventions are lifesaving and dignity providing and that scientific evidence and public health research identifies these as most effective and best practice thank you to Dan WB D Kent and Selena pie for sharing this research today as a home reductionist I know that home reduction the idea of supporting people to be safe in all of their choices is fundamentally necessary to the kind of City Toronto is is and wants to be as a community member I am tired of watching my neighbors and friends and family die and as a neighbor I am angry that my fellow neighbors are speaking over me when they say that these programs make their neighborhoods more dangerous to them and to their children we are at a turning point in public health policy and Toronto has a choice to make both about public health policy but also about the soul of who this city is for people who use drugs live in Toronto they always have and they always will they are our friends and our neighbors and our convenience store owners and our dog gomers they belong here and they deserve evidence-based support they will not disappear if we defund these supports they will be forced to exist in parks and alleys and in bathrooms defunding supervised consumption sites and injectable opioid agness treatment will not make us safer it will not make the streets less chaotic and it will not stop children and finding needles defunding these programs will lead to both children finding bodies it will lead to the paramedic and emergency medical system being even more overwhelmed with repeat calls responding to overdoses that could be supported calmly without a lock Zone and without hospitalization at sites that are already embedded and trusted by the community financially ethically and politically and medically we cannot afford to defund these programs Toronto must increase funding for these programs and expand them significantly as well as push to decriminalize substance use to combat the illicit toxic drug Supply and replace it with a regulated Supply and a suite of public supports most importantly Toronto as a city must Advocate to fential and federal government for the expansion of Home reduction services and to com combat the misinformation campaign and moral Panic that is positioning home reduction and Recovery against each other as well as people who use drugs against their neighbors this is our City and we must stand together to protect our most vulnerable and our neighborhoods uh thank you thank you very much any questions for the deput uh seeing none thank you for coming in today Ola uh next up is Colin Johnson Toronto H reduction Alliance are you here with us no we don't see Colin in the room or online we'll move on to uh again help me pronounce this properly masquin masquin agu Toronto IND indigenous harm reduction good morning my name is Miss gon agu I'm a d and cre woman from Salt River First Nation and a Toronto resident I work with Toronto indigenous harm reduction as well as Street Health Ops I'm speaking to you in regards to the proposed budget which does not include expenses to run safe consumption sites while many of the council members have expressed solidarity with harm reduction workers and people who use drugs in the city it is clear that the council has accepted the closure of these spaces I'll remind you that this decision was reversed back in 2018 when people access safe consumption site spaces they are not only in safe place to consume drugs they are accessing countless Referral Services many of our clients depend on these spaces to support their overall health and well-being and the month of September many of you will be wearing orange shirts and giving land acknowledgements you will talk about our trauma and our stories you're talking about the people I serve and my own family members indigenous people make up the highest demogra demographic of people who access these Spaces by making the clear and conscious decision to not include SCS operational costs in your budget has been made clear once more that the city of Toronto does not care about indigenous people as council members you have the decision-making power to say no to Heart tubs which will merely act as drop in centers and only offer half of the services that SCS bases provide as council members of the Board of Health you should know that Force treatment is not evidence-based as council members you will be held accountable for the wave of drug poisoning preventable spread of infectious disease and death that is to come should SCS no longer be operational in the city of Toronto the empty statements of solidarity and keeping SCS sites open are meaningless without your option the commitment to keep SCS operation costs in your budget despite policy change it is clear that the council has already accepted the decision to close SCS sites which many of us are fighting to reverse we are calling upon you to be bold and take leadership we will not accept that these matters are out of your control my relatives deserve to live another and they deserve one more Sunrise thank you councelor perks go ahead uh Gord are you're mute thank you very much for those very powerful words um you you mentioned that uh forc treatment is not evidence-based could you talk a little bit more about that yeah so definitely having access to treatment is part of harm reduction uh should that be what the individual chooses unfortunately that's often not the first mode of care that um is available to people uh we know that waiting lists are incredibly long and so by the time that people are ready to go into medical detox or any form of treatment um you know it it's it's often not the first um Avenue that people will take when accessing care um and so often times uh an SCS and Ops is is a way for them to access those services but by simply coming in and being in a safe place to consume uh their drug of choice um before they could they can get to that step if that's what they choose so so the evidence is then that the the person who uses drugs has to be the one to decide when they're ready to go into treatment is that fair that's correct yes okay so how having having uh life-saving and supportive frankly uh safe consumption spaces opens that path so that when a person is ready then they they can take it if they wish yeah and so many different Avenues whether that be um you know a safe Supply or you know choosing abstinence or choosing what we refer to as recovery that's that's up to them yeah and can be referred to those from SS bases great thank you so much uh any other questions to deput see n thank you for coming in today I appreciate that uh Owen Evans Unity Health Toronto he online no uh Evan's not in the room or online so we'll go to the next person Hannah stall Toronto metropolitan University you here online okay Hannah you can mute yourself you have five minutes go ahead can you hear me we can't hear you though can you hear me now yes we can go ahead you have five minutes sorry about that um I'd like to thank the chair and membership of the board for allowing me the opportunity to speak today I'm speaking as a constituent of w 10 a street nurse that has provided Health Care access to unhoused torontonians for half a decade and a grieving sister who lost her older brother to preventable overdose seven years ago with Toronto now facing the imminent threat of having five of our overdose prevention sites set down put down my clients and community need the city to take bold Swift action to protect those most threatened by the moral Panic afflicting the provincial government I applaud the counselors here who have taken the time to visit a supervised consumption site and see firsthand the beautiful work that we do it's a privilege as a nurse to be able to offer gentle low barrier Health Care to people who are often enduring the hardest moments of their lives every day these sites continue to catch torontonians when they fall through the cruxs sites have been intentionally placed in areas of greatest need re research tells us that overose prevention sites reduce overdose deaths in a 1 kilometer radius by 2/3 as has been mentioned previously today sites decreased hospitalizations among people who use drugs for debilitating wounds by about half and reduce Regional ambulance calls for suspected overdoses by 2/3 of course as we know sites also significantly reduce transmission of HIV and hepatitis C and I also want to mention that there's yet to be any validated data linking overose prevention sites to crime in fact oh sorry my apologies sorry continue okay um I think it's important to note that in fact Toronto police services own publicly available data indicates that these sites help reduce most forms of crime the site that I work out of is in W 13 and we see an average of 600 visits every month and reverse on average 38 potentially deadly overdoses each month these are individuals who can go on to contribute to their communities access treatment and won't be dying preventable accidental deaths in public spaces without these safe sites Toronto will see a significant rise in public drug use discarded paraphernalia ambulance calls transmission of various blood infections and overdose deaths um I want to urge the city to use this critical moment to declare Public Health Emergency as we stand to lose the final tool that we have in the toxic drug crisis within which we find ourselves the city of Toronto must publicly acknowledge the stress this decision is going to be putting on our Municipal Health infrastructure and put pressure on the province to reverse this decision that flies in the face of all research ethics and clinical guidelines if needed my clients Community need the city to implement interim solutions to keep our sites open and explore alternative funding to these essential Services the province has stated has stated that they will not approve any new sites so it's of utmost importance that the city step in so that we do not forever lose these indispensable sites that we already have thank you thank you very much uh Hannah any questions for the deput see none thank you for coming in today uh next up is sah Raza Daily Bread Food Bank are you here online okay want to unmute yourself sorry my video doesn't seem to be working can folks see we can hear you though so you could you could uh start brief yeah thank you um good morning chair and board members and thank you for the opportunity to speak with you today my name Isa and I have the privilege of looking as vice president of research and advocacy at Daily Bread food food bank which is a member-based network over 200 food banks and meal programs across Toronto working to end hunger and poverty in our city in all parts of the city outside of North York uh from which you already heard uh from my colleague Sarah in addition to the horrifying statistics that Sarah from North York harvis spoke to earlier today about child hunger in our city and among our food bank clients I wanted to share the scale of unsustainable demand that we are seeing at our Toronto food banks today uh just a few months ago our Network served over 350,000 Food Bank clients for the first time that's the highest we've ever served in a single month and it's four times our pre-pandemic levels for reference this could fill the Rogers Center over seven times more than one in 10 torontonians now rely on food banks to survive and we continue to see increased demand from families with children and of course even more torontonians are facing food insecurity but not even making it to the doors of our food banks which we know is the case for many single parents who Face Time and resource barriers to accessing services like ours importantly food insecurity is not just about momentary hunger it has severe and long-term implications on the mental and physical health of Children and Families and that's why I'm here today to urge this board to continue calling on the provincial and federal governments to increase and immediately flow funding for uh for the student nutrition program beyond the inflationary increases being considered today uh Toronto just just about the program Toronto has the largest scale of need for a student nutrition program in Ontario and yet the lowest funding per student and due to inadequate funding we see inequities across the city with some schools able to offer full meals thank thanks to supplementary funds from outside the program some schools unable to provide more than half half an apple and a cheese string and then some schools not providing any meals at all to students in greatest need and that's really concerning because no child can learn and grow in a healthy way on an empty stomach and we also know that students being left behind are disproportionately lowincome racialized newcomer facing a disability or intersection marginalized in in some way we hear stories from our food bank clients not only about child hunger but also about parents doing everything they can and to ensure that their children are fed throughout the school day leaving the parents themselves to go hungry face health challenges and forgo basic items and services including things like internet and so on which many of us take for granted and this in turn has proven mental health consequences for their children we also hear stories about single parents and Refugee families being forced to survive on only $700 a month through Ontario Works because they are unable to find employment as they struggle to provide child care and food for their children throughout the Summers when schools are closed as my colleague Susan mentioned earlier today the city has extended its definition of student nutrition to include Summers and our clients need an expansion of corresponding summer food programs we therefore urgently call on on this uh committee and the city to work with the provincial and federal governments to increase and immediately flow their promised investments in Toronto's student nutrition program so that no child goes hungry and students across the city get the support they need to learn grow and Thrive and as various speakers have made clear today a fully funded Universal and yearound student nutrition program could go a long way in creating a more Equitable City and improving not only food and security but also mental and physical health amongst families with children who are struggling to secure their basic right to food uh as you know you have a partner in us at Daily Bread food bank and we are ready to work with you to make this a reality thank you very much for your time thank you very much Zahara any uh questions for the deput seeing none thank you so much next up is Lindsay Jennings are you here online hi there can you hear me we can you have five minutes go ahead okay thank you very much H good morning my name is Lindsay Jennings and I'm I am a research associate at Carlton University with the tracking and Justice project where we track deaths in custody I'm also a community investigator at McMaster University Department family of medicine where I lead a prison health research Council made up of people with lived experience I am someone who survived substance use survived homelessness and survived incarceration I used drugs in a time where there was no SCS very minimal harm reduction supports there was very limited supports for women coming out of jail let alone women who use drugs which created a cycle of going back to environments that were not safe or stable for myself I am speaking out today as an indiv as individuals being released from jail is the responsibility of municipalities supervised consumption sites are offer significant benefits for people being released from jail during a vulnerable time helping them navigate the transition back into the community more safely the operational budget and massive defunding of the oat program and SCS programs are going to cause more overdose deaths for those was being released from jail a recent study in the medical journal PL P1 found that 16% of all toxicity deaths in Ontario occurred among people who had experience of incarceration it also found that overall risk jumped substantially when co9 emerged with a slew of Public Health restrictions that reduce services but the increase in Risk was particularly large for people who have been behind bars or released defunding sces and other harm reduction Services removes the only only service I'm going to repeat that it removes the only service that individuals being released from jail who use substances can access that provides immediate non-judgmental care and connects individuals to broader support systems SCS offers clean needles and Other Drug supplies which helps prevent the spread of bloodborne diseases like HIV and heepsy which are more common among people with a history of incarceration SCS reduces the incident of public drug use and the associated issues of discarded needle and public intoxication which are often concerns in community and lead people back into the cycle of incarceration also SCS often provides access to other critical services including addiction treatment mental health wound care Food Services and other social services this is crucial for people leaving jail who may need assistance with housing employment or health care in August of 2015 Brad Chapman died as he was discovered unconscious with drug paraphernalia around his body on Walnut Street in downtown Toronto during the Corner's inquest Brad uh during the Corner's inquest it was identified that Brad Brad was released from jail just two weeks before his fatal overdose it was heard that he was not properly helped by the police when he was found when asked if her son would have benefited from the the in injection sites that have opened in Toronto since Brad's death Bren Chapman said absolutely she praised Toronto Moss Park harm reduction site which opened against City regulations in 2017 as a highly successful operation and said her son would have most certainly used one of these sites rather than using drugs on the street Karen Chapman said she'd like to see The Province open more over those prevention sites in response to her son's death it would have been perfect for him she said I know we need more of those the recommendations from the inquest outlines the need to expand services for individuals being released from jail we also know from a recent report from the John Howard Ontario called locked up and locked down not the immediate action and investment in supportive and affordable housing options for justice involved individuals supported by SCS Ops and harm reduction supports and services would help save lives reduce harm support public health and safety it would also be coste effective to invest in the expansion of these sites and increase funding for the other social services and current harm reduction programs offered within the sites my call on today is that the Board of Health should reverse the defunding of the O8 programs that supervised consumption sites and all of their staff in order to save the lives of the people you are responsible for in the city and is continuously ignored by the Ontario government thank you uh thank you very much any questions for the deput seeing none thank you for coming in today thank you and uh Justin arza are you here online Justin Ara you have five minutes go ahead Justin thank you to the Board of Health for allowing me to speak today my name is Justina I'm a healthcare provider Community member and constituent of the city and word n I'm here to speak on behalf of the closure of s consumption sites across the city and change and form reduction supports I'm also here to paint a picture of what being in front line of this work looks like as a healthcare provider throughout the GTA I understand and acknowledge how many lives these sites have saved and health risks health risks have been reduced the lives of many people I support the closure of these sites is a death sentence it will result in Mass deaths and put an increased burden on healthcare services that are already crumbling where people will have un will have to use unsafe spaces to use substances and there will be more public drug use including needles I work within a team that provides Outreach and primary care support to un shelter torontonians what the how what the announcement and plan for heart hubs fails to acknowledge is that many of these supports already exists the decision uh this decision fails to acknowledge that we need a spectrum of care that includes harm reduction treatment and everything in between we don't need one or the other as a team social worker I support folks with housing application system navigation accompanyment to appointments and hospital visits I ensure they stay connected to registered nurses and and family physicians for medical treatment interventions and access to Safe Supply I support folks uh and referring them to additional service services that are imperative to their health and to access support for their substance use and all spectrums from home reduction supplies uh safe consumption sites detox outpatient and inpatient supports and to achieve whatever goal they desire in the recovery Journey we as a team we work collaboratively with the lowest barrier supports including safe consumption sites dropin churches they help us pave the path between life-saving care safe consumption sites and drop-ins C call us often and say hey this person is here looking for you and we go to meet them they are not only vital to keeping the people that we support alive but they're imperative and ensuring that they stay connected to the people that they trust to their main supports the difference is that um safe consumption sites of reading and science evidence based practice and they understand that people cannot reach recovery if they die before their name reaches the top of a weit list and this announcement the government fails to acknowledge that safe consumption sites are a place that many many torontonians call homes because this is all they've got this is the place that they often turn to when there is nowhere else to turn systems put in place by our provincial government repeatedly fail or margin or most marginalized communities my clients have been discharged from hospital hospitals to streets at times medically stable on paper but left to keep postoperation wound cleans and wounds clean in tense bus stops Alleyways our team is often called to emergency departments general medicine wings and icus to meet clients and hopes for them to continue their care once they return to the streets it is almost impossible to heal without own I Echo many of the words um that the deput before me have shared after the announcement that 10 uh Ontario safe consumption sites including the five Toronto sites I will be forced to close many of the clients that receive care in these spaces and through our team feel as if the government wants them dead providing empathy in these times is simply just not enough we are tired of grieving this is a public health emergency this will not go away and we need you to name it for what it is I insist on the torona board of health to take Swift action to ensure the ongoing operations of safe consumption sites har reduction services on a full spectrum we welcome this funding but at that it shouldn't come at the cost of what we already know exists and works this has been proven please please we call on you to ensure this permanence of these life- saving Services thank you thank you so much uh any questions for the deput uh seeing none thank you for coming in today um is Colin Johnson here or o Evans no neither of those two are here okay that's so that ends our our um deputations for today on this item any questions for directors I do uh Mr chair okay go ahead Council Bravo thank you um thanks to everyone who's out to depute I I wish I could be there in person but I'm sick um to staff um and through you chair I'd like to ask um if it's clear to all of us um would you agree that the full impact of both the funding and the program funds um on the provincial changes that have been announced to supervise consumption and harm reduction Services it's still yet to be fully understood um and will and will we be receiving a report to this board um really outlining the full impact um in in the coming future so through you Mr chair I I'm sorry uh counselor it was difficult to hear your question I do believe you were asking about reporting back to the board in respect of the impact I do want to ask if we fully understand at this time what the impact will be and if there will be an opportunity in the future for this board to receive a report outlining that impact once it's it's really uh been clear been made clear so through the chair yes of course as we get more details and are able to um articulate what the anticipated impact of the proposed policy change is we will certainly bring that here to the board for your consideration and deliberation I do want to be very clear though that the reflections here within the budget are just that they are reporting back to the board in respect of budgetary changes as we understand them that the federal government has has uh funded us for certain programs specifically the injectable opioid Agonist treatment program until the end of March and we have no further word from them around ongoing dollars by the same token with the provincial policy change we've heard that funding for the current supervised consumption service that we've been operating at The Works since 2017 will end as of March 31st so what you're seeing in this budget report is our current understanding of the financial situation for 2025 as we understand it now premised on the word we have received from both the feds and the province it in no way indicates what our stance is in respect of what's needed according to the evidence to address the drug toxicity epidemic that is faced in this city I've been very clear about that from the beginning of my days here at Toronto Public Health I will emphasize once again for the benefit of the board that it is a comprehensive Continuum of services yes exactly as people have said here harm reduction and treatment are part and parcel of that Continuum and interestingly what we haven't heard as much but is crucial from a public health perspective is prevention prevention harm reduction treatment treatment both in the acute case and in The Chronic uh ongoing sense along with all the supports that actually make all these Services more successful or more likely to be successful housing income supports connections to community and social supports these are the kinds of things that are necessary in order to to appropriately address the drug toxicity epidemic that we are witnessing here in this city and Beyond thank you my mic is off uh councelor perks go ahead you have five minutes thanks and and Mr chair so you know I've spoken with legal offline so I don't need to go in camera um to the medical officer of Health I a number of deput made the point that uh treatment by itself will not not create the kind of outcomes we want and that harm reduction is a crucial pillar in any approach do you agree with that so through the chair yes as I've just said I think an entire Continuum of service prevention harm reduction and treatment and those are much deeper issues each one of those it is much uh right treatment takes multiple forms as does harm reduction as does prevention all of them are needed thank you um additionally a number of people made a very specific point which is unless you have a safe consumption service of some kind uh there will be more deaths do you agree with that so through the chair I think even as we have seen even with supervised consumption Services We are continuing to see deaths related to the drug toxicity epidemic there's no question we have had an impact we have seen a reduction um in with with supervised consumption services but I think we should be clear that we need the a full spectrum of interventions from prevention to harm reduction and treat I just need a very specific thing so yes so supervised consumption okay thank you um additionally some some of the people making deputations made the point that by closing supervised consumption Services we will have a negative impact on the capacity of tonal paramedic and our emergency rooms and other aspects of the healthcare system do you agree with that so through the chair I suspect that that will be true the extent to which we will see that I don't know that any of us can really say but yes I anticipate there will be impacts on Health Care Emergency Services and Paramedic Services as well to say nothing of the other social services that support those who are experiencing substance use challenges uh particularly those who are experiencing homelessness as well okay and uh just two questions to legal which I think we can can ask in public uh first there has been a Supreme Court decision in the past that says that access to to Medical Services like safe consumption services are a right and that the federal and provincial governments cannot take that right away from people is that correct through the chair I'm I'm generally familiar with that case yes okay and additionally uh whether the province order these orders these sites closed or not it's within the purview of this board to allocate money which could be spent uh to which could potentially be spent on these Services we can allocate that money correct yes the the funding decisions are separate from any legal prohibition which we haven't seen yet so that's correct thank you Mr chair those are my questions okay thank you any further questions from anybody I have a question go ahead uh councelor shis Kaja five minutes trusty but don't wish that on me um it's um through you U Mr chair I I just have a question I just want to thank the delegates um who came forth to to speak about the food nutrition program we of course at the school board constantly grapple with this um and just sort of have uneven our programs are um so there are a few delegates who spoke to the fact that the commitments we've made have not been necessarily the targets we'd set for ourselves so is it safe to say that um this will only co uh cover the inflationary cost that we will not actually be able or have the capacity to open in New sites so through the chair um uh trust sis cond I'm not sure I understand entirely the question um sorry could you reiterate I I I don't mean to make it more complicated yeah no just the the last part I'll repeat um the cost that we're dedicating to the food nutrition programs that's only to cover the inflationary costs the increases so we're not going to be H be able to have the capacity to open any new programs or support any new programming so through the chair No in fact what we have put forward uh for the board's consideration is both something to account for the increased cost of food and some dollars towards increasing the capacity uh the number of students that are actually covered by the program perfect thank you uh that's how I read it but I did hear some of the delegates I just wanted to clarify for them um do we have any insights to how many programs or how many students will be able to feed with the new proposed members so through the chair as I understand it and I'm looking to my colleagues I believe we have counted both for an increased cost of food and an expansion of the program to another 5200 students that's correct that's correct okay thank you um that's my only question we'll have an opportunity chair to speak on this after right this is just the question period that's correct you would speak up to five minutes on this item thank you uh Council Thompson I think I saw your hands up go ahead you did thank you very much Mr chair through you to Dr Dilla Dr Dilla um Vancouver has uh recently not renewed their lease with respect to their harm reduction facility is that correct uh through the chair I am actually not sure um I'm happy to look if they're familiar yeah they have and I I'm just curious and I was going to ask you you know sort of what the impact has been so maybe I'll just um uh save that for another day because many years ago I visited that facility as to your predecessor predecessor from a long time ago um had asked to to visit and I think um councelor perks and I we uh and others work really hard to help the city in terms of establishing its um drug um prevention uh policy and so on because I really wasn't one back in the day and I know that my visit there was very helpful in helping me to be more informed actually that it does actually work so I guess my question to you then given the provincial decision um and I'm not really clear is it simply I mean part of it is funding but is there an issue with respect to location as to where the facilities can be located as part of the recent um decision made by the province that has an impact with respect to where these facilities can actually locate so through the chair I am a little loathed to speak on behalf of the province but as I understand right as I understand the information um they have indicated that uh they have uh launched a move to establish this demonstration project for these heart hubs and with that they have indicated their intent to cease funding and the operations of certain supervised consumption services including five here in the city of Toronto one of it one of which is the service that we as Toronto Public Health have been operating since 2017 uh my further understanding is that the reason why those places were chosen at least in part and again I'm not speaking for the provincial government I'm giving you information as I understand uh and that which has been communicated to us is that they are um interested in seeing a uh a a separation a distance of 200 meters between schools and or child care facilities and the presence of supervised consumption services and it's my understanding that the locations that have been designated for closure uh and defunding are uh in violation of that new policy direction that the province has set we further understand that there is impending legislation that they are going to introduce this was again made as a provincial announcement uh last month the details of which have yet to be released or really therefore analyzed and understood by our team or frankly by anybody else who is currently an operator of supervised consumption service but as mentioned in an earlier answer to one of the questions uh certainly as we get more information and have something to report um to the board we're happy to uh bring that back I so I think that's H the situation as I understand it thank you very much for that Dr Dilla and certainly by no means were I asking you to speak on behalf of the province it was simply the clarification and obviously you've expressed um with respect to your answer given me more detail so that's very helpful thank you very much for that notwithstanding that fact though uh given the limitations and the um distance uh policy that the province has actually highlighted in order for us to move forward and to help those who are in need of help the city of Toronto if we're not being funded by The Province May then have to come up with a budget to respond to the needs that exists in our city would that be um safe to sort of make that comment or that injector in terms of a position that we would have to adopt obviously will be a cost but at the end of the day overall it could be great benefits in terms of saving and health care and so on so through the chair uh certainly when we come as your staff to this board with recommendations around what can be done within the purview of Public Health to improve health and to protect Health within the city uh we are coming to you uh with budget requests and or with recommendations of course when it comes to issues that are more related to health care uh this is where it gets a little more delicate healthc care has traditionally been funded and is the purview of the province uh so it becomes an interesting uh balance that the board and or Council needs to strike in respect of how much health care you wish to engage in uh and you wish to uh fund versus that which should fall under the provincial purview thank you thank you Mr chair thank you councilor Thompson uh any other questions of Staff um director Roy go ahead five minutes thank you chair uh to you chair to medical officer of Health uh we just heard that uh with the new proposed budget you are adding 5,200 students in the student nutrition program now is that inclusive or exclusive of potential Federal funding that might come towards that line Sor I through the chair that does not give consideration to Federal funding this is just Municipal funding that we're proposing to both meet the uh increased in the increase I should say in the cost of food and to allow for a further expansion of the program excellent and uh potentially hopefully there will be funding coming by 2025 beginning and if it does do we have the capacity to quickly pivot and uh expand that program right away through the chair uh as you know we've been uh strong advocates for a national school food program we are looking forward to hearing about what our federal uh Partners have in mind for us in terms of how much money we might expect to receive given their announce ment earlier this year we have not received any word yet but certainly um we are prepared to work with other partners uh uh should we hear something in respect of how much uh we might uh get from the federal funding announcement thank you very much Mr chair H thank you any further questions seeing none okay so we'll go to um speakers now I go ahead councelor perks thank you Mr chair uh members I I want to address specifically the lines in the draft budget uh having to do with safe consumption services and and exchange services I understand the chair has a motion that he's circulating that removes the cuts right the budget proposed cutting those two lines because we've heard from the Federal and provincial governments they won't be subsidizing it the chair's motion removes those cuts so keeps them in the budget this does a couple of things first of all it uh stays with Council and this board's policy that super supervised consumption services are a necessary Health Service that's also something that the Supreme Court of Canada has recognized so we put we keep the money in and that puts the city in a position to keep trying to make the argument that the federal and provincial governments need to come back to the funding table for these services and that's something that I hope that all of us on this board will be advocating for in the coming weeks and months because as you heard from the both the academic experts the people who run Services people who use drugs and people who are direct service deliverers you cannot substitute prevention for harm reduction harm reduction is a necessary tool in Saving Lives that's very clear you also heard if that's not an adequate argument a very powerful argument about the knock on effects throughout the rest of the Health Care System we would literally be making Health Care Services worse for everyone in Toronto if we just folded up our tent and let the province have their way here this is a moral imperative many of you will know the name the term social murder that's when the actions of a society or a government contribute directly to the deaths of some of the people in that Society the province's decision here is a clear-cut case of social murder many many of the people that we are here to represent on this board whose Health interests we are supposed to advocate for will lose their lives if the province continues down this path I and I know many other members of council are outraged by this and we will be fighting The Province on this issue and I think that today we can begin that fight by sending a signal that we will keep the funding for these services in our budget and that we need to Advocate collectively as torontonians to save lives and to stop using stigmatizing politics uh as a way of gaining power at the expense of lives of people we represent thank you okay thank you Council perks uh others to speak Council Bravo go ahead I can go after yourself chair if you want to introduce your motion I know you can go ahead I can do it after okay um I first want to thank all of the deput that came in today the the eloquence and Clarity around um uh both uh uh safe injection harm reduction services and uh student nutrition programs is really important for this Board of Health to hear and I think you find you will find a lot of support um and Alignment as uh Council BRS has indicated I will be supporting the chair and his motions um to uh ensure that while the decisions that have been made at the provis level um are very specific and The Province does have the power and authority to overrule the work of the city of Toronto we um we need to not foreclose the fight that's going to happen um in civil society and with allies in public health to make sure that this decision is reversed uh we can't give up this fite it's too much work has been done members of this committee have been here uh longer part of bringing these services to Toronto uh and but I also want to just point something out public health is a social movement uh we have water testing because people were uh fighting uh the deaths that were happening in Toronto before water testing and these population level interventions often start here um this idea um this the the subversive uh bringing of these services into Toronto by civil society and social movement actors is the reason that we have these services in Canada because people fought for organized um and Lisk a lot to make sure that we're taking care of each other uh we cannot have a a a good society in which we deem certain people Expendable and if we're going to have a society worth a name then we meet people where they are where their needs are and provide Services um that are appropriate and this is a Health Care Service um as the medical officer of Health has indicated but I think uh by adopting these motions from our chair uh we will indicate that in the fight to save lives to create Pathways for a good life for people who are using drugs um wherever they're coming from um we are be partners in that fight we are supporting um we are creating the conditions enabling our social movement Partners to uh not give up um and to continue it's the same with student nutrition the idea of leing children largely started in this board I I have to say that uh you know 20 years ago I was um working um in in the schools as a as a parent act um leader um and we extended at the time uh student nutrition to second school students it was of the importance of making sure that they had a meal to be able to stay in school um these things are tied to me they're they're about ensuring that people have the tools and the resources that they need to uh Thrive and survive um um not just survive but Thrive so I I appreciate the um the intelligent and fact-based information that's been shared here I want deput to know that we agree um and that we are as concerned and horrified about the decisions that are being made on the backs of people who are vulnerable um to politicize and to polarize in this country and this Board of Health I hope will take the side of uh what is right what is proven and what actually shows the care that is needed to um protect Public Health in the city and in the this country thanks Mr chair thank you councelor Bravo um trusty Kaja go ahead you have five minutes thank you um you know I just wanted to share a few thoughts on the student nutrition program uh there's not really much more I can add from the the delegates uh who made such powerful and impactful statements uh something we continue to Grapple with I know we're waiting for federal fund but you know until we see the impacts in schools um I think we're very very cautious about that um I'm happy that we've made commitments or um the board has made commitments uh but we still have so much more work to do uh I know uh my fellow trustees have reached out and said that you know they really wanted me to share some of the issues we deal with at the board because it just you know the day-to-day functioning of these programs might not be something that everybody here understands um just because the decisions are often so far removed uh from those who are actually living um these programs many depants mentioned the increase in poverty um the fact that these programs rely so heavily on donations um that becomes even harder to run when in a climate of fiscal insecurity amongst the general population so those who who give are just not able to give uh also these programs are volunteer run uh so you know people are not are stretched for time uh capacity uh it makes these programs really dependent on oftentimes neighborhoods are able to call L you know networks that not everybody necessarily has and so when we think about food programs it's not just the actual Foods themselves but how are we delivering it how are we ensuring this consistency in in that um and what we're seeing is that despite increases in dollars there's continuing to be decreases in what they can actually provide and I think you know the deputat as one mentioned there's programs that they're only able to give an apple and a cheese string and you know that that's not necessarily um you know that's in conflict with the food guides that we recommend so I I I think there's there's a lot of mismatch here happen but you know thank you to the Board of Health uh thank you to all the deput I just want to make sure that we always keep this in in top of mind uh since we're so close to the promise of a potential national food program in a way that we haven't been in a long time uh but also very cautious um until that actually rolls out and happens so thank you thank you for these important conversations today thank you truste sh Raja any other uh speakers in this item director Roy go ahead five minutes uh Mr chair thank you very much first of all thanks all the depants for amazing presentation um I want to talk I'm going to circle back on what trusty Raa was talking about is a student nutrition program first of all chair thank you so much for the uh motions that you are going to put forward we saw the draft of it uh the federal program on a national school food program uh we do not want that to be another $10 daycare Fiasco we do not that $10 daycare is not important but now we heard from Daily Bread we heard from nor york Harvest about the magnitude of the problem in our communities and we see it on a daily basis we need action now and I'm glad that we are going to try to have this conversation to make sure by 2025 uh in the beginning of 2025 we can try to get some funding to increase those numbers however I also want caution that this is not something to rejoice and sit back because all we are getting nationally is $200,000 a year which is not even a drop in a bucket and that conversation needs to be pushed and continued and we have On The Board of Health for years and years had this conversation about asking the feds to come forward for the student nutrition program and we have got something and I'm thank for but this is not where it stops as a board of health we need to continue this conversation we need to start uh we need to start asking for more and actually making food a human right for our students and for our communities thank you uh thank you uh any other speakers in this item okay seeing none okay I'll then proceed to uh speak to my motions uh the first one uh staff can put up it's around what council perk spoke about in regards to adding um the funds for the social safe consumption sites to the city budget uh I want to give credit to council perks he's worked with staff and myself on this item it's proposing that the board of help request the mayor to propose a in the 2025 operating budget the the cost the entire cost for the for safe consum sites at a cost of 285,000 eight uh yeah 898 uh to for 2025 again Public Health was notified by the province that they would stop um funding for this so legally they've had to bring this forth so so again we're asking that the city take this on and proceed proceed period until further notice until the province says to us that we cannot proceed with this but um I think we have to proactively do this um majority of State consumption sites that are closing will be in my ward in Toronto Center uh people in my community will be mostly affected by this uh I spent the last couple weeks going to different safe consumption sites across the city and also in my ward and talking to the staff and to the clients themselves and talking about the fear and the harm that they feel if safe consumption sites are closed so again um I think it's been well articulated by the depants and uh many of my colleagues here on this and the vital importance of the services in regards to Har reduction and the safe consumption sites so I hope that uh my colleagues will support me on this um on this motion the second motion that I'm asking staff to put up is around uh requesting the government of Ontario to continue um funding safe consumption sites and harm reduction Services um and also to allow the the hard hubs to allow them to have safe consumption sites as well within their their um their doors because as it stands now as we've been we've been advised that is not the case and we know that it's a Continuum of Care when it comes to harm reduction and um let follow the science right not the politics and so I am standing with the science and with our caregivers and the experts in the field to make sure that this very vital important service continues and it does save lives as we've heard the uh my third motion is around um student nutrition I losing my track of my notes so um we're asking that the medical offic of Health um coordinate with the city manager to engage the government of Canada on the 2024 federal budget commitment so for 2024 we're asking for the $79 million be front loaded so that we can actually provide food nutrition to uh our kids in our schools in uh Toronto and for the 2025 budget that $220 million uh be forwarded to the city of Toronto for safe uh for student nutrition services again as many of the depants mentioned and also trust ises can mentioned uh this is vitally needed um here and uh we really should make it a priority and reaching out to the to the government of Canada uh is one of the first steps to do that so again um those are the those are the uh the Motions I if you have any questions I'm happy to answer any questions you we have sorry we also need a motion to extend and we also need a motion to extend before we vote on that I um will put a motion forward to extend uh to the end of the meeting end of the agenda all those in favor oppos Carri thank you if there are no questions to my motions we could uh put them back up on the screen and we V them one by one okay could we record this please sure um clerks will will proceed with the recording of votes thank you members this is a recorded vote on item HL 16.2 motion a moved by councelor Moyes when I call your name please indicate your vote director Bravo in favor director chander Balon is not present I'm sorry uh director Malik director Moyes in favor director morle in favor thank you director UD in favor director perks in favor director Roy in favor thank you director Shish karaja in favor thank you and director Thompson if he's online still in favor thank you sorry I couldn't see all the the thumbnails thank you and director xia present thank you the vote uh excuse me the motion carries unanimously okay do you also want the second one um recorded as well Council perks no okay second motion okay all those in favor opposed carried thank you and the third motion all those in okay okay all those in favor of this item oppos carried thank you item as amended all those in favor opposed Carri thank you all right which one's it three okay yeah yeah we also need to vote in HR 16.3 all those in favor of uh the item oppos carried all righty good so we're now at should do that now then a lot going on here today I also need to introduce a new business item put on the screen it's yep critical needs for universal student nutrition this recommendation is uh requesting the medical office of Health to report directly to the October 9th 2024 meeting at council with a phased in plan to implement a universal School food program in January 20125 if the federal funding flow flows by November 2024 including uh prioritizing of the more than 40 School communities that recently applied for a program and were denied due to lack of funding okay uh let's vote on this item to add it to the agenda very good okay all those in favor oppos carried that's added thank you the next item okay item 16.6 Council bravy held that item uh Dental Mobile Care Program there are no um deputat on this item so you you can go ahead and ask questions if You' like uh thank you um uh Mr chair I just have um I don't need to ask questions but I do have a motion okay um if unless others have questions um uh that the Board of Health requests the provincial Ministry of Health to allow the proceeds of the auction of Toronto Public Health dental bus estimated at between 40 to $50,000 to be retained by Toronto public health and applied towards the purchase of a new mobile Dental van um I feel that it's important to ask this um of the Ministry of Health uh because our dental program um is something that's so crucial and I think that that tonal public health and uh Board of Health for its advocacy over the years around universal access to Dental Care um especially for those most vulnerable um is something that we should legitimately proud of and and and uh continue to upold um it's an easy win for the provincial government here um to continue to support our local public health Dental Programs without new spending so this is a a smart money motion um it's it's a request uh currently we auction the existing bus which is at end of life we're required to return the funds to the province when we when we do the auction um I think it's important to um to give the provincial government uh the opportunity to allow us to keep the pro uh proceeds of the auction so that we can purchase a new dental van which is also approved in this item um if the provincial government agrees this would uh generate a you know a savings to to Toronto public health of 40 to $50,000 and in these Financial constraint um I hope that they agree thank you councelor Bravo any questions of the uh mover I seeing none okay all those in favor of uh the motion oppose carried as amended okay as amended all those in favor opposed carried thank you and the next item is uh appointment of members of the our health our city implementation panel consideration uh Deputy Mayor Malik wanted to speak to this item or you have any questions of this item I don't have any questions but okay anyone else have questions of this item seeing none okay speak to it go ahead um thank you very much I'm very honored to be speaking to this item today uh when we launched our health our city last fall we launched our city's new strategy for mental health and substance use and we reaffirmed our commitment as a board to the mental health and well-being of every torontonian and to addressing the health and the social impacts of substance use and as we know there is absolutely no one who is untouched or unaffected by the impacts of mental health and substance use in our city and as we're seeing across the province and in the country as well we see and feel this in our circles and in our communities every single day and we are facing serious challenges that exacerbate the ways that we are able to address this crisis drug toxicity High living costs housing accessibility and the lingering impacts of the covid-19 pandemic which is why our work together is even more critical more important and more timely and as a city we must care for each other creating community and building a city where our sense of belonging strengthens us and allows us to to be more capable in addressing this crisis with its with the seriousness that it requires and we know the importance of policy based evidence-based mental health and harm reduction supports and how they can build a safer more inclusive Toronto and also set an example right across the province and Country and we know that this implementation panel is also coming at an incredibly challenging time we heard that here at the meeting today a critical time time where lives are at stake even more heightened across Toronto and across the province and decisions being made by other levels of government have serious serious ramifications for the health and well-being of our neighbors our communities and our city and I'd like to thank everyone who applied put themselves forward to be on this panel for stepping up and providing leadership to our city to improve supports and services save lives and it is some of the most challenging and most important work that there is and it is undeniably important in this moment and we'll all continue to have an important role to play everyone who did raise their hand put themselves forward will continue to be part of this work together with us and the work that we are doing collectively as a board to see this strategy implemented I want to just share a few specific thank yous to the fellow members of the review panel that brought forward this this set of participants um to the implementation panel as we move forward of course Dr Eileen Dilla and Dr Stephanie zoo and to OA and kir kirana and uh Vanessa from Toronto public health for all of your incredible support and coordination and for the thorough work in in following up and reaching out to everyone who expressed their interest and being a part of this process especially as we embark on the implementation of this really critical strategy in this moment thank you very much thank you deputy mayor uh okay we can vote all those in favor of adopting the um recommendations opposed carried thank you next item is item 16.8 I spoke to this briefly already it is the um second all right thank you uh so this is the the empo item as I mentioned that there are limited U organizations that actually can um administer the empo vaccine and so we're asking uh Health Canada to allow others to be able to do that for example even pharmacies for example so um yeah so all those in favor fav of this item opposed carried thank you the next item uh is Sur the critical needs for universal student nutrition which I just spoke about just recently and the medical office of Health working with um presenting at council at the October 9th meeting uh talking about the funding for the universal School food program so all those in favor of the item opposed and that's carried thank you um that's it that's it so the me meeting is adjourned you felt a little messy back and forth but I think we but we got through it so thank you staff thank you uh my colleagues thank you everyone and uh see you at the next meeting have a great afternoon e