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From YouTube: Board of Health - April 15, 2019
Description
Board of Health, meeting 5, April 15, 2019
Agenda and background materials:
http://app.toronto.ca/tmmis/decisionBodyProfile.do?function=doPrepare&meetingId=16410
Meeting Navigation:
0:06:21 - Call to order
Agenda Items:
0:09:44 - HL5.1 - Consideration of the 2019 Provincial Budget (Ward All)
A
You
can
follow
the
agenda
and
the
debate
on
your
computer,
your
tablet
or
your
smartphone
at
Toronto,
GA,
/,
Council
and,
of
course
the
Board
of
Health,
acknowledges
the
land.
We
are
meeting
on.
It's
the
traditional
territory
of
many
nations,
including
the
Mississauga's
of
the
credit,
the
Anishinaabe,
the
Chippewa,
the
hona
shown
a
and
the
wind
at
people's,
and
it
is
now
home
to
many
diverse
First,
Nations,
Inuit
and
métis
people's.
We
also
acknowledge
that
Toronto
is
covered
by
treaty
thirteen
with
Mississauga's.
A
At
the
credit,
this
special
meeting
of
the
board
is
scheduled,
as
I've
said,
under
unprecedented
circumstances.
To
respond
to
the
budget
members
of
the
board
is
this
is
a
special
meeting
under
the
Board
of
Health's
procedures
by
law.
The
board
may
only
consider
business
on
the
agenda,
so
there
will
not
be
new
items
of
business.
A
A
Alright,
that
motion
has
moved
all
those
in
favor
opposed
of
any
that
carries
so
the
order
for
which
we
are
going
to
proceed.
Today.
We
have
a
presentation
from
our
medical
officer
of
Health.
Admittedly,
the
budget
only
came
out
late
on
Thursday
afternoon,
so
they
have
rushed
to
bring
us
the
information.
That's
in
front
of
us
following
the
presentation
from
staff.
We're
then
going
to
proceed
to
deputations
before
going
back
to
ask
questions
of
staff.
A
I
would
just
note
off
the
top
two
members
of
the
board
that
many
of
you
I
know
are
seeing
patients
and
have
appointments
starting
at
3:00
p.m.
and
so
in
this
interest
of
time,
I
will
keep
a
close
eye
on
the
clock
for
quorum
with
that
housekeeping
items,
as
we
are
sitting
in
the
council
chambers.
When,
when
we
get
to
the
point
of
speaking
and
asking
questions,
you
will
raise
your
hand
you're
not
signing
up
to
using
the
buttons
to
sign
up
to
question.
A
You
can
raise
your
hand
as
we
normally
would,
but
you
do
have
a
microphone
there,
on/off
to
speak
just
like
if
we
were
in
committee
and
also
there
are
washrooms,
often
reserved
for
counselors
and
staff
that
are
open
to
everybody
which
are
just
behind
me
here.
If
you're
looking
don't
go
downstairs
or
down
the
hall
with
that
housekeeping
I'm,
going
to
turn
it
over
to
our
medical
officer
of
health,
eileen.
B
B
Hang
on
a
second
we're,
okay,
so
here
we
go
just
to
give
you
a
sense
as
to
what
the
current
status
of
public
health
in
Ontario
is.
There
are
currently
35
local
public
health
units
across
the
province
and
there
are
3
different
governance
models
for
the
various
health
units
across
the
province.
We
have
a
unique
model
here
in
Toronto
in
that
we're
a
semi
autonomous
board,
but
there
also
exists
boards
of
health
across
the
province
that
are
autonomous
and
those
that
are
formed
as
a
part
of
single
tier
and
or
regional
government.
B
Just
to
give
you
a
high-level
summary
as
to
what
the
responsibilities
and
obligations
are
for
local
public
health
units.
There
are
many
but
they're
generally
summarized
within
the
Ontario
public
health
standards.
There
are
obligations
and
responsibilities
of
local
public
health
articulated
in
the
health
protection
and
promotion
Act,
which
is
a
provincial
piece
of
legislation,
and
indeed
there
are
40
other
provincial
acts
that
delineate
obligations
and
responsibilities
that
local
public
health
units
have
to
the
communities
that
they
serve.
B
There
is
also
an
important
function
held
by
the
medical
officer
of
Health
as
advisor
to
the
Board
of
Health
you
as
members
of
the
Board
of
Health
and
to
City
Council,
and
to
give
you
a
sense
of
the
gravity
and
the
importance
of
the
position.
It
is
a
position
that
is
not
only
appointed
by
the
city,
but
that
set
that
appointment
as
medical
officer
of
Health
has
to
be
approved
by
the
provincial
Minister
of
Health,
the
provincial
Minister
of
Health
and
long-term
care.
B
Excuse
me,
and
the
chief
medical
officer
of
health
for
the
province
as
well,
but
fundamentally
when
we
look
at
the
medical
officer
of
Health
as
the
lead
of
the
local
public
health
agency,
the
medical
officer
of
Health
in
concert
with
all
the
staff
of
that
local
Public
Health
Unit
and,
in
this
case
we're
talking
about
Toronto
Public
Health.
We,
together
as
a
team,
are
responsible
for
protecting
the
health
of
Torontonians.
B
Turning
over
to
you
in
your
capacity
as
members
of
the
Board
of
Health
and
what
the
role
of
city
government
is,
we
do
have
a
City
of
Toronto
act
that
delineates
the
role
of
City
Council
and,
as
I
mentioned
earlier
in
the
presentation,
Toronto
does
have
a
semi-autonomous
board
of
health.
You,
as
members
of
the
Board
of
Health,
have
the
authority
to
set
policy
direction
and
when
it
comes
to
budget,
there
is
a
relationship
that
occurs
with
City
Council
as
well.
So
that's
why
the
nature
of
the
board
is
characterized
as
semi-autonomous.
B
City
of
Toronto
has
important
roles
in
respect
of
appointing
you
as
members
of
the
Board
of
Health,
as
I
mentioned
earlier.
They
have
an
important
role
in
terms
of
appointing
me
as
medical
officer
of
Health.
They
approve
our
local
public
health
budget
and
they
provide
the
fund
of
the
public
health
staffing,
the
team
effectively
that
is
charged
with
that
responsibility.
That
I
talked
about
about
creating
a
healthy
City
for
all.
B
So,
turning
now
to
the
mission
of
Toronto
Public
Health,
this
is
something
that
you've
heard
me
say
many
many
times
that
we
have
fundamental
roles
around
creating
a
healthy
City
and
there
are
main
our
main
objectives
are
to
improve
the
health
status
of
the
population
and
to
do
so
in
a
fashion
that
reduces
health
inequities.
We
have
to
prepare
for
and
respond
to
outbreaks
and
emergencies
as
part
of
our
important
role
in
health
protection
for
our
population,
and
if
we
are
successful
in
terms
of
achieving
those
objectives,
we
contribute
to
a
sustainability
to
the
sustainability.
B
Excuse
me
of
the
healthcare
system,
so
the
simple
way
that
I
try
to
put
this
when
I
describe
the
role
of
Public
Health.
Our
job
is
to
ensure
that
the
population
we
serve
starts
off
their
life
healthy
and
stays
that
way
for
as
long
as
possible.
And
if
we
have
a
healthy
population,
we
effectively
have
a
population
whose
need
for
health
care
for
acute
services
is
reduced,
or
at
least
delayed
for
as
long
as
possible.
B
Again
talking
about
our
mandate
in
more
specific
terms,
this
slide
articulates
that
which
we
are
responsible
for.
We
have
key
roles
in
respect
of
preventing
the
spread
of
disease,
promoting
healthy
living
and
advocating
for
conditions
that
actually
improve
the
health
status
of
our
population
and
reduce
inequities.
We
want
to
have
a
healthy
population
that
actually
has
the
smallest
possible
gap
between
those
who
enjoy
excellent
health
and
those
who
enjoy
lesser
health.
We
want
to
reduce
that
gap.
We
have
a
key
responsibility.
We
are
fundamentally
scientists.
B
B
Each
dollar
that's
put
into
public
health.
Every
$1
invested
in
immunization
saves
16
dollars
in
healthcare
costs.
Every
$1
invested
in
tobacco
prevention,
tobacco
use
prevention,
saves
20
dollars
in
healthcare
costs.
There
are
very
very
few
if
any
arenas
within
the
healthcare
system
in
treatment
that
get
you
that
kind
of
return.
This
is
an
incredible
value
proposition.
B
So,
turning
now
to
the
specifics
of
the
provincial
budget,
as
it
was
brought
forward
last
Thursday,
what
we've
done
is
in
these
slides
in
the
next
two
slides
were
characterizing
again
at
a
very
high
level,
as
the
budget
was
just
announced
a
few
short
days
ago.
The
specific
impacts,
as
we
see
them
and
as
we
know
them
and
understand
them
premise
on
the
information
that
was
provided
in
the
budget
document.
So
with
respect
to
direct
impact.
B
What
what
was
out
in
the
provincial
budget
in
terms
of
its
impact
on
public
health,
was
adjusting
provincially
provincial
municipal
cost,
sharing
of
public
health
funding.
However,
there
were
no
specific
details
provided
in
the
budget
document
around
what
the
nature
of
that
adjustment
might
be.
The
provincial
budget
also
articulated
that
the
plan
is
to
establish
10,
Regional,
Public
Health
entities
and
10
new
regional
boards
of
health,
with
a
common
governance
model
by
the
year,
2020,
2021
and
finally,
in
terms
of
direct
impacts,
as
we
can
understand
them
from
the
budget
document.
B
The
budget
document
projects
an
annual
savings
of
200
million
dollars
to
be
effected
by
2021
2022
through
regionalization
of
the
local
public
health
units
and
to
governance,
changes
related
to
public
health
units
with
respect
to
impacts
that
I
would
characterize
as
more
indirect
in
nature.
What
the
provincial
budget
document
articulated
was
an
intent
to
ensure
that
public
health
agencies
focus
their
efforts
on
providing
more
efficient,
frontline
care,
and
it
spoke
specifically
to
efficiencies
that
would
be
obtained
through
you
know:
streamlining
digitizing
and
coordinating
certain
back
office
processes.
B
However,
the
specifics
were
not
provided
in
the
budget
document.
Other
indirect
impacts,
as
we
see
them
that
were
articulated
in
the
budget
document,
talked
about
the
plan
to
develop
a
regional
strategy
to
modernize,
Ontario's
public
health
laboratory
system.
And
finally,
there
was
a
comment
made
with
respect
to
streamlining
public
health
Ontario,
and
this
is
the
exact
wording
to
enable
greater
flexibility
with
respect
to
non-critical
standards
based
on
community
priorities.
B
B
So
what
does
this
mean
in
terms
of
financial
impact
for
Toronto?
Well,
to
give
you
a
sense
of
the
context,
the
provincial
public
health
budget
allocation,
so
that
which
is
allocated
to
local
Public
Health
from
the
Ministry
of
Health
and
long-term
care?
Currently
is
approximately
750
million
dollars
a
year
and
the
current
Ministry
of
Health
and
long-term
care
contribution
to
Toronto,
Public
Health
currently
sits
at
about
a
hundred
and
forty
seven
million
dollars
a
year.
B
So
I
mentioned
to
you
that
one
of
the
direct
impacts
and
what
was
stated
in
the
budget
document
was
an
intent
to
reduce
200
million
dollars,
costs
of
two
hundred
million
dollars
to
the
local
public
health
budget
by
twenty
twenty
one.
Twenty
two.
This
gives
you
a
sense
as
to
what
is
currently
being
spent
across
the
province
and
the
component
of
that
which
actually
goes
directly
to
Toronto
Public
Health.
B
So
just
coming
up
to
my
last
slide.
Mr.
chair,
what
I'd
like
to
just
emphasize
to
the
Board
of
Health,
is
that
you
know
as
members
of
the
Board
of
Health,
you
know,
I
would
like
to
think
that
we've
actually
had
an
engaged
in
conversation
around
that
which
is
public
health.
We
are
your
advisors
and
we
are
also
here
to
effect
programs
policies.
B
Services
to
deliver
such
that
Torontonians
are
able
to
enjoy
improved
health
status,
reduce
disparities
in
health
status
and
to
ensure
that
we
as
a
city
and
as
a
local
public
health
department,
are
ready
to
respond
to
and
were
prepared
to
respond
to
outbreaks
and
emergencies
so
as
to
protect
the
health
of
the
population.
In
so
doing
these
things
we
effectively
enhance
the
sustainability
of
our
health
care
system
and
play
a
fundamental
role
in
that
regard.
In
supporting
the
healthcare
we
offer
incredible
value
for
money.
B
The
return
on
investment
for
investments
and
resources
that
go
into
local
public
health
is
well
documented
and
I
believe
well
understood
by
you
and
perhaps
needs
to
be
better
understood
by
our
greater
population.
The
challenge,
of
course,
is
that
when
public
health
works
well,
it's
not
always
obvious.
When
you
work
in
the
realm
of
prevention.
The
effect
of
prevention
is
that
it
looks
like
nothing
happened.
There
was
no
outbreak,
people
are
healthy,
they're
thriving.
It
looks
like
nothing
happened,
but,
as
you
know,
as
members
of
the
Board
of
Health,
it
was
a
significant
something
right.
B
The
most
valuable,
nothing
that
there
is
right
is
good
health,
no
outbreaks,
a
thriving
community.
That's
not
a
nothing,
it's
actually
a
very
valuable
something.
So
there
is
a
significant
value
proposition
to
public
health,
and
there
are
elements
there
are
key
elements
that
need
to
be
in
place
in
order
to
maximize
that
value
proposition
that
we
provide
as
public
health.
B
I've
articulated
to
you
the
importance
of
the
relationships
that
we
have
with
our
municipal
sector,
so
much
of
that
which
drives
health.
What
actually
creates
good
health
is
not
within
the
scope
of
the
health
care
sector,
but
rather
in
the
hands
of
those
who
work
in
the
municipal
sector,
elements
such
as
housing,
income,
education.
These
are
things
that
actually
are
implemented
on
municipal
lines.
There
are
also
community
partners
and
agencies
who
form
an
important
component
of
that
which
creates
a
healthy
community.
So
what
we're
talking
about
here
is
ensuring
that
those
relationships
are
actually
provided.
B
The
circumstances
that
they're
allowed
to
flourish
and
grow
and
really
provide
excellence
in
service
and
excellence
in
the
conditions
being
able
to
respond
to
local
needs
to
actually
address
the
specific
needs
of
the
community
requires
a
local
focus
with
clear
local
representation
and,
finally,
I
would
put
to
you
that
accountability
and
oversight,
or
best
determined
by
a
model
of
governance
that
actually
reflects
the
populations
health
needs
and
reflects
the
circumstances.
The
unique
circumstances
of
the
community
in
which
they
live.
B
A
Thank
you.
Dr.
Davila
were
going
to
proceed
now
to
deputations.
Before
we
return
to
our
medical
officer
of
Health
for
questions
we
have,
we
will
have
three
deputies
here
today.
You'll
notice,
Loretta
Ryan
is
on
the
list,
though
she
is
not
de
PUE
ting
I
we
have.
The
first
will
be
dr.
Robert
Kyle,
then
dr.
David
Mowat
and
then
former
chair,
Joe
majimak,
dr.
Robert,
Kyle
I'll.
Invite
you
to
the
front
dr.
A
Kyle
is
the
president
of
the
Association
of
local
public
health
agencies,
as
well
as
the
medical
off
sir
of
Health
for
Durham
you'll,
have
five
minutes
doctor
and
there's
a
clock
on
your
left
and
right,
which
I'll
begin
when
you,
when
you
start
and
two
members
of
the
board,
there
will
be
a
chance
for
up
to
five
minutes
for
each
member
of
questions
when
you're
ready,
dr.
Kyle.
Thank.
C
Thank
You
mr.
chair
I
have
a
copy
of
my
prepared
remarks,
which
we
gave
to
the
Secretariat
to
distribute
to
the
to
the
chair
and
members
of
the
Board
of
Health
and
I'll.
Just
read
through
my
prepared
remarks
so
good
afternoon,
chair
and
members
of
the
Toronto
Board
of
Health
and
dr.
Davila
medical
officer
of
Health
and
your
team
members
who
are
present
I'm,
dr.
C
Robert
Kyle,
president
of
the
Association
of
local
public
health
agencies,
better
known
as
alpha,
and
have
had
the
honor
and
pleasure
as
serving
as
a
local
medical
officer
of
health
in
Ontario
for
over
30
years.
As
you
heard
with
me,
as
Loretta
Ryan,
whose
Alfa's
executive
director
alpha
represents
all
Ontario's
35
boards
of
health
and
medical
officers
of
health
and
alpha
has
been
very
engaged
with
the
2019
and
Theriault
budget
deliberations.
C
Since
January
of
this
year,
On
January
25th
in
the
Alpha
pre
budget
submission
Alpha
noted
that
public
health
is
on
the
front
line
of
keeping
people
well.
Public
health
delivers
an
excellent
return
on
investment.
Public
health
is
an
ounce
of
prevention
that
is
worth
a
pound
of
cure.
Public
health
contributes
to
strong
and
healthy
communities,
and
public
health
is
money
well
spent
and
I.
Think
dr.
Davila
presentation
has
certainly
amplified
that
message.
Furthermore,
alpha
recommended
that
the
integrity
of
Ontario's
public
health
system
be
maintained.
The
province
continued
its
funding
commitment
to
cost
shared
programs.
C
On
the
same
day,
alpha
released
its
public
health
resource
paper
entitled
improving
and
maintaining
the
health
of
the
people,
the
contribution
of
Public
Health
to
reducing
hallway
medicine,
which
has
been
shared
with
the
premiers
Council.
The
paper
was
developed
to
explain
the
work
of
the
public
health
sector
and
to
highlight
the
important
role
that
the
sector
can
play
in
eliminating
hallway
medicine
by
reducing
the
demand
on
hospital
and
primary
care
services.
C
As
you
may
know,
this
work
is
organized
in
the
interior
public
health
standards
as
follows:
chronic
disease
prevention
and
well-being,
emergency
management,
food
safety,
health
equity,
healthy
environments,
healthy
growth
and
development,
immunization,
infectious
and
communicable
diseases,
prevention
and
control,
population,
health
assessment,
safe
water,
school
health,
substance
use
and
injury
prevention.
The
paper
concluded
that
the
public
health
sector
serves
the
people
of
Ontario
to
ensure
that
healthy
people
can
support
a
strong
economy,
providing
a
direct
economic
impact.
C
Coordination
of
responses
to
community
health
concerns
such
as
mental
health
and
addictions,
in
partnership
with
community
level
organizations
reduction
on
pressures
on
doctors
and
hospitals
by
concentrating
on
the
communing
community
starting
at
birth,
and
a
significant
cost
effective
contribution
to
eliminating
hallway
medicine.
It
is
with
the
foregoing
in
mind
that
alpha
stated
in
its
news
release
regarding
the
2019
Ontario
budget,
that
is
surprised
and
deeply
concerned,
to
learn
the
government's
plans
to
restructure
Ontario's
public
health
system
and
reduce
its
funding
by
two
hundred
million
dollars
per
year.
C
The
reality
is
this:
200
million
dollar
savings
is
a
20
percent
reduction
in
the
already
lean
annual
provincial
investment
in
local
public
health.
This
will
greatly
reduce
our
ability
to
deliver
the
frontline
public
health
services
that
keep
people
out
of
hospitals
and
doctors
offices
I
go
on
to
or
the
news
release
goes
on
to
comment
on
the
expert
panel.
It's
in
writing,
and
all
I
would
say
is
that
in
its
response,
Alfa
noted
that
public
health
initiatives
show
a
return
on
investment
and
the
health
protection
and
promotion
needs.
C
Some
int
Aryans
vary
significantly,
depending
on
their
community
Alfa
concluded
that
it
looks
forward
to
receiving
more
details,
so
it
can
work
with
the
ministry
and
other
key
stakeholders
to
preserve
essential
frontline
health
protection
and
promotion
services.
In
closing,
Alfa
welcomes
the
Toronto
Board
of
Health
and
its
other
members,
reflecting
on
the
Fort
Garry,
foregoing,
amplifying
the
messages
contained
therein
and
modulating
them
as
they
see
fit.
Thank
you
for
inviting
us
to
appear
as
a
deputation
and
we're
happy
to
take
your
questions
at
any
time.
Thank
you.
Thank.
D
You,
dr.
Kyle,
so
I
want
to
make
sure
I've
understood
something.
You
said
in
in
your
presentation.
You
said
that
they
proposed
reduction
I'm,
not
going
to
call
them
savings.
The
proposed
reduction
is
26%
of
the
annual
spending.
That's
correct,
okay
and
I,
assume
that
you
know
having
been
in
government
for
a
while.
D
D
D
E
Yes,
thank
you
very
much,
I'd
like
to
follow
up
with
the
Ontario
public
health
standards.
This
goes
through
the
kind
of
areas
that
public
health
units
that's
correct,
would
deliver
programs
in
and
are
we
seeing
that
some
or
do
you
expect
that
some
will
be
the
focus
of
this
reduction
in
funding
more
than
others,
or
so.
C
So
I
think
we're
all
awaiting
further
details
from
the
ministry.
Whether
specific
changes
to
the
standards
are
directed
provincially
versus
determined
locally.
We
don't
know
we're
waiting
for
details
to
the
extent
that
all
of
the
standards
are
delivered
by
frontline
staff
and
to
the
extent
that
it's
extremely
unlikely
that
efficiencies
can
account
for
200
million
dollars
in
cuts.
Then
it's
hard
for
me
to
not
think
that
essential
frontline
services,
including
the
suite
of
programs,
listed
under
Ontario
public
health
standards,
will
be
affected.
E
E
C
So
if,
if
you
did
that
across
the
board-
and
you
were
proposing,
say,
26
percent
reduction
in
funding
to
our
chronic
disease
prevention
program
say
off
the
top
of
my
head,
that
would
be
a
26
percent
reduction
of
say
two
million
dollars
there
abouts.
So
I
can't
do
the
math
at
the
off
the
top
of
my
head,
but
it's
a
significant
cut
which
would
amount
to
I,
don't
know
eight
or
ten
staff
something
along
those
lines
and
are
we.
C
With
respect
to
chronic
disease
prevention,
there
is
a
preventive,
a
component
which
includes
public
health,
education
and
so
forth.
There's
an
enforcement
component
say
with
respect
to
Toronto
to
tobacco,
vaping
cannabis
that
sort
of
thing,
there's
advocacy,
work
and
there's
the
provision
of
say
frontline
cessation
services.
So
it
depends
on
the
program
itself
and
what
programs
are
currently
in
place
at
a
local
public
health
unit
as
to
what
may
be
impacted,
I'd.
E
C
Again,
it
would
adversely
affect
your
staffing
and
it
depends
how
many
staff
you
have
allocated
to
that
program
as
to
what
it
would
look
like
I
think
it's
fair
to
say
that
that
would
be
one
of
your
programs
that
don't
have
a
lot
of
direct
full-time
staff
to
it.
So
you
would
probably
preserve
the
staff,
in
our
case
Durham
Region.
We
have
two
staff
that
work
on
this
file
for
full
time.
C
C
Yes,
it's
heat
and
weather-related
out
my
neck
of
the
woods,
and
probably
in
Toronto
as
well.
It's
nuclear
emergency
preparedness
as
well,
although
not
not
specifically
in
the
program,
emergency
of
management.
Of
course,
we
respond
to
infectious
and
communicable
diseases
on
a
24/7
basis
as
well,
and
it's
part
of
the
I
would
call
the
local
public
health
and
safety
infrastructure
that
was
your
class
Thank
You
councillor.
F
C
F
The
second
question
is
I
noticed
in
the
actual
budget
it
made
reference
to.
The
government
will
be
to
remove
the
back
office
uncle
from
the
budgets
document,
removing
the
back-office
efficiencies
through
digitizing
and
streamlining
process.
What
does
that
mean
to
you,
as
the
medical
office
of
Health,
for
Durham,
for
dealing
with
those
vulnerable
constituent
that
you're
trying
to
serve?
What
does
this
really
mean.
C
So
I'm
I
work
for
a
regional
government,
and
so
we
get
a
lot
of
our
IT
HR
finance
services
from
the
Regional
Municipality,
so
taking
it
for
what
it
says.
Presumably
we
would
delink
ourselves
from
the
regional
government
and
then
link
ourselves
to
a
new
regional
entity
and
have
them
provide
the
finance
the
HR,
the
IT
infrastructure
that
we
currently
get
from
from
regional
government
I
think
it
depends
on
whether
you're
autonomous
versus
semi,
autonomous
versus
regional
government
or
single-tier
as
to
how
difficult
this
could
be
for
smaller
health
units.
C
F
Last
question
mr.
chair,
with
regard
to
the
Public
Health
lab
I,
remember
the
SARS
I,
remember
walking!
So
what
does
that
really
mean
Wendy
the
proposed
budget
asking
for
modernization
of
the
Public
Health
Laboratory
system?
How
does
that
going
to
transform
or
improve
the
services
for
you
at
the
medical
office
of
Health
order
and
for
the
public
health
agency
yeah.
C
So
the
short
answer
is
we
don't
know
what
that
means.
We
rely
on
private
and
public
laboratories
for
support
at
the
the
front
lines.
The
bottom
line
is:
if
there
are
any
changes
to
the
laboratory
system
as
users
of
that
system,
we
will
be
directly
impacted,
particularly
if
specimens
that
we
currently
submit
to
the
laboratory
system
are
either
somehow
disrupted
or
there
are
changes
in
terms
of
timeliness.
That
sort
of
thing
I'm
sure
that's
not
the
intent
here,
but
we
just
don't
know
what
those
words
mean.
F
Kyla,
thank
you
very
much
for
your
deputation.
As
we
know,
reductions
in
front-line
programs
affect
the
most
vulnerable
populations,
probably
the
most
so
as
medical
officer
of
health
for
Durham.
How
do
you
think
this
200
million
dollars
of
savings
are
going
to
affect
the
disparities
in
health
not
only
throughout
Ontario,
but
certainly
in
your
region?.
C
Well,
that's
excuse
me:
that's
a
tough
one,
I
think
most
public
health
units
apply
a
health
equity
lens
in
determining
where
they
can,
where
they
provide
programming,
what
populations
they
target
with
their
programming,
and
my
my
hope
and
my
expectation
is
that
all
public
health
units
at
the
end
of
the
day
will
continue
to
apply
a
health
equity
lens
in
terms
of
its
own
programming
and
services.
But
at
the
end
of
the
day,
if
there
are
fewer
programs
and
services,
then
priority
populations
will
feel
the
pinch
as
much
as
the
general
population.
G
Thank
You
chair
and
thank
you,
dr.
Kaul,
for
your
reputation.
I
wanted
to
return
to
the
portion
of
the
budget
that
mentioned
streamlining
public
health
Ontario,
to
enable
greater
flexibility
with
respect
to
non-critical
standards
based
on
community
priorities.
In
your
view,
what
does
that
mean
and
which
standards
might
be
considered?
Non-Critical
I.
C
C
G
Thank
you,
a
follow-up
question
around
you
mentioned
you
know
D
linking
from
municipal
governments
and
aligning
with
some
new
authority
yeah.
Is
it
a
fair
assessment
to
suggest
that
the
direction
here
is
a
stronger
alignment
with
the
health
care
system
and
if
so,
what
may
be
be
the
impacts
of
that
shift?.
C
I
think
what
that
means,
but
it's
a
pure
speculation
on
my
part,
is
to
the
extent
that
public
health
programs
and
services
can
keep
people
healthier.
Then,
and
you've
heard
from
me
and
from
dr.
Davila
about
return
on
investment
and
so
forth.
It
means
that
the
demand
on
public
demand
on
acute
care
services
and
the
cost
therein
could
be
present
per
prevented
in
the
long
term.
So
that's
what
I
think
integration
with
the
healthcare
sister.
C
That
system
means
I
hope
it
doesn't
mean
that
scarce
public
health
resources
will
somehow
be
used
in
the
acute
care
system
to
deal
with
sick
patients,
but
I
wouldn't
rule
that
out
because
we
don't
know
what
the
details
are.
But
I
can
only
refer
to
the
two.
What
I
know
about
the
expert
panel
report
and
I
think
it
was
all
about
reducing
demand
on
acute
care
services.
Okay,.
G
C
Think
the
timelines
I'm
just
speaking
personally
I'm,
not
speaking
on
behalf
of
alpha,
are
widely
overall
overly
optimistic,
the
the
creation
of
10
new
regional
entities,
in
our
case
D
linking
and
then
linking
and
so
forth.
To
my
mind,
this
is
a
multi
multi-year
project
and
in
terms
of,
are
there
going
to
be
any
savings
along
those
lines
and
so
forth?
I
just
think
it's
overly
optimistic,
quite
frankly,
but
that's
a
personal
view
and
and
I'm,
not
speaking
on
behalf
of
alpha
necessarily
thank.
G
A
Thank
you
very
much.
Well,
thank
you,
dr.
Ryan
or
dr.
Kyle.
Excuse
me.
Our
next
speaker
is
dr.
David
Mowat,
dr.
Mowat
is
a
two-time
former
chief
medical
officer
of
health
of
Ontario,
as
well
as
being
the
former
medical
officer
of
Health
for
Durham
or
for
Kingston
and
Peele.
Dr.
Mowat
you'll
have
five
minutes
when
you're
ready,
Thank.
H
You
mr.
chairman,
I'm
speaking
to
you
today
from
the
perspective
of
someone
who
spent
40
years
in
public
health
at
all
three
levels
of
government,
and
my
first
observation
is
over
that
time.
I
have
witnessed
the
waxing
and
waning
of
support
for
public
health
in
cycles
that
start
with
a
reduction
in
funding
leading
to
the
degradation
of
the
public
health
infrastructure
and
then
outbreaks
of
disease,
followed
eventually
by
public
concern
and
some
re-infuse
in'
of
funding.
So
this
is
not
you.
H
You
can
certainly
see
evidence
of
that
cycle
in
the
reports
over
the
years
from
just
Escriva,
the
Auditor
General
of
Canada
and,
of
course,
the
reports
on
Walkerton
and
and
SARS
they've.
All
borne
that
out.
We've
also
seen
that
the
changes
to
the
cost-sharing
formula-
that's
a
road
we've
been
down
before
including
one
period
of
three
years,
filled
with
sequential
changes
which
landed
us
right
back
where
we
had
started
so
now.
H
We're
seeing
proposed
changes
in
the
Ontario
budget,
which
will
undoubtedly
impair
the
capacity
of
health
units
to
do
their
job
in
protecting
and
promoting
the
health
of
the
public
when
Public
Health
is
working
well,
as
dr.
Davila
has
mentioned,
nothing
happens,
we
don't
see
headlines,
saying
child
didn't
get
meningitis
today,
for
example,
and
we
have
a
mandate
which
is
concerned
very
much
with
very
long-term
results,
and
many
of
the
beneficiaries
of
our
public
health
programs
are
people
who
would
not
have
a
strong
voice
to
advocate
for
themselves.
H
H
It's
well
accepted
that
over
the
past
century
or
more,
we've
seen
an
increase
in
life
expectancy,
and
that
has
been
due
to
better
living
conditions
and
interventions
of
a
public
health
nature,
but
there's
also
clear
specific
evidence
and
just
to
throw
some
more
onto
the
pile
you've
heard
about.
From
the
last
two
speakers.
H
So
time
is
short,
I
just
want
to
move
quickly.
Now
onto
the
issue
of
the
potential
impact
of
some
of
these
changes
and
a
response.
Of
course,
you
will
want
to
shape
the
final
form
of
policy
as
much
as
you're
able,
including
the
critical
issue
of
governance,
which
you've
all
obviously
already
taken
in
hand,
but
also
to
consider
how
to
accommodate
significant
reductions.
H
We
cannot
afford
to
turn
our
back
on
these
pressing
issues.
So
let
me
get
to
the
point
about
this.
A
rather
three
points
number
one.
These
conditions
are
largely
a
consequence
of
how
and
where
we
live,
work,
grow
and
play
number
two.
The
population
prevalence
of
these
conditions
will
not
be
reduced.
H
A
H
Sense,
I
will
wrap
it
up
in
a
sentence.
There
are
opportunities
here
to
enhance
the
role
of
science
and
to
choose
evidence,
driven
priorities
and
programs
to
in
address
the
very
serious
concerns
we
have
about
trends
in
mortality
and
mobility
in
our
population
and
in
addressing
equity
as
well,
and
we
need
to
turn
to
addressing
them.
Thank
you
that.
A
A
A
H
A
great
many
I
was
in
fact
quite
involved
in
one
of
those
reports,
after
Silas
the
Naylor
report,
and
what
we
learned
and
we
expected
dr.
Naylor
to
come
out
and
saying
this
is
all
about
managing
infectious
diseases.
And
what
he
came
out
and
said
was
this
is
about
the
infrastructure
of
Public
Health.
It's
about
the
adequate
staffing,
the
type
and
skill
level
of
the
staffing
that
we
have
our
system
of
governance,
our
system
of
information
management
and
the
application
of
evidence
and
science
and
a
number
of
other
things.
H
Objectives
of
the
healthcare
system
are
to
improve
prognosis,
alleviate
pain
and
suffering
and
conserve
capacity
at
the
individual
level,
and,
of
course
this
is
absolutely
vital
work,
but
in
public
health,
our
concern
is
not
within
the
with
the
just
with
the
individual.
It's
about
the
entire
society
and
what
we're
trying
to
do
as
you've
heard
from
dr.
Davila
is
to
improve
the
health
status
of
of
the
population
as
a
whole
and
also
to
address
the
inequities
in
health
status
that
we
observe
within
that
population,
and
we
sometimes
neglect
those
too.
A
H
Well,
I'm,
obviously
not
included
in
their
discussions
that
went
on
leading
up
to
this,
and
you
know
I
think
we
have
to
recognize
that
there
are
enormous
pressures
in
everything
that
government
does
fiscally,
including
the
health
care
system,
but
there's
always
I
think
a
temptation
and
and
I
worked
with
Carolyn
Bennett
I
always
used
to
remember.
She
would
speak
about
the
tyranny
of
the
acute
and
it's
that
we
do
tend
as
human
beings
to
look
in
this
short
term
and
investment
in
public
health
really
brings
these
benefits.
H
That
we've
talked
about
these
returns
on
our
investment
many
years
down
the
road,
and
it
requires
a
certain
amount
of
discipline,
I
guess
to
say
we
are
not
going
to
let
this
go.
We
are
going
to
invest
for
the
future,
so
a
cut
in
funding
for
Public
Health
impairs
our
health
in
the
future,
not
necessarily
just
here
and
now.
Thank.
G
H
Well,
I
work
with
hospitals
touches
on
a
number
of
things.
Obviously,
the
first
one
that
springs
to
mind
is
infectious
diseases,
and
that's
I
mean
I
could
talk
about
that
for
a
very
long
time,
but
obviously
hospital
staff
make
observations
about
what's
happening
and
they
need.
We
need
a
relationship
between
hospital
staff
as
well
as
we
care
staff
and
others
long-term
care
also
to
maintain
surveillance
of
infectious
diseases
so
that
we're
able
to
to
spot
trends.
H
H
Is
that
there's
a
lot
of
interest
in
public
health
now
in
identifying
people
who
are
admitted
to
hospital
for
reasons
related
to
tobacco,
smoking
who
are
still
smoking,
and
you
know
how
can
we
identify
these
people
and
help
them
put
them
into
a
system
which
is
going
to
give
them
the
help
they
need,
including
you
know,
access
to
pharmaceuticals,
to
help
them
quit
smoking
and
to
follow
them
over
time,
and
so
that's
a
example
of
a
partnership.
That's
know
infectious
disease
that
shows
Public,
Health
and
Hospitals
working
together,
Thanks.
H
Well,
I
want
to
give
this
answer
with
preface
it
with
recognizing
that
everything
just
about
everything
we
do
involves
other
partnerships
and
particularly
in
the
NGO
sector
and
other
community
groups,
as
well
as
other
professional
groups
and
Loretta
ryan
over.
There
is
a
perfectly
good
example
of
you
know.
As
a
city
planner,
you
know
who
do
we
work
with?
So
very
often
it's
orchestrating
the
people
who
are
involved
in
a
particular
issue
that
is
out
very
often
outside
the
healthcare
system,
which
affects
our
ability
to
enjoy
good
health.
H
So
if
you
can
take
example
of
how
we
build
cities,
the
built
environment,
for
example-
so
that's
public
health
is
not
the
lead
right.
City
Planning
departments
are
the
lead
for
that,
but
there
have
been
innumerable
examples
of
those
two
groups
coming
together
together
with
NGO
groups
who
could
be
interested
in
cycling
or
the
environment
or
anything
I'm
working
together
to
improve
how
we
lay
out
our
cities
on
the
basis
of
an
enormous
pile
of
science.
H
G
H
Well,
when
you
go
into
a
hospital
with
an
acute
illness,
you
would
expect
that
the
first
thing
that's
going
to
happen
is
you're
gonna,
listen
to
your
story,
examine
you
and
give
you
some
tests
right.
So
why,
in
public
health,
would
we
just
rush
out
there
and
do
stuff
without
assessing
what
the
situation
is
and
understanding
it?
Here's
a
condition:
how
is
it
distributed
in
the
population
is
over
time?
Is
it
getting
better
or
worse?
H
Are
we
better
or
worse
than
the
people,
next
door
and
so
on,
and
to
do
that
for
diseases,
for
mortality
for
injuries,
for
risk
factors
and
for
determinants
of
health,
so
that
we
have
a
complete
picture
of
the
health
of
a
population
and
it's
quite
technically
challenging
and
takes
a
long
time,
but
that's
the
nature
of
health
status
assessment.
It's
the
diagnostic
phase
of
practicing
public
health.
A
I
In
preparing
for
this,
these
a
few
words
I
thought
I
would
kind
of
review
all
those
phrases
that
we
have
as
human
beings.
That
say,
you
know
what
we
could
do
this
now,
but
it's
gonna
hurt
us
later
on,
so
we
have
phrases
like
Pennywise,
pound-foolish,
pound-foolish
or
pay
me
now.
A
little
bit
or
pay
me
a
lot
later
on
or
haste
makes
waste
or
short-term
action
versus
long-term
planning.
I
The
one
that
I
think,
though,
is
the
best
is
an
ounce
of
prevention
is
worth
a
pound
of
cure,
because
that's
really
what
this
debate
is
kind
of
all
about
the
cuts
that
are
being
proposed.
My
math,
in
dividing
200
million
dollars
of
cuts
over
750
million
dollar
budget,
is
that
the
cut
will
be
twenty
six
point.
Six,
six,
six
repeated,
that's
the
that's
the
number
and
for
this
in
Toronto,
will
be
something
like
40
million
dollars
on
an
annual
basis.
That's
not
small!
I
That's
a
major
cut
to
the
way
we
we
do
our
Public
Health
work,
and
so
the
question
is:
is
this
wise?
Is
this
the
kind
of
thing
that
that
we
want
to
do
the
medical
officer
of
Health
dr.
Davila?
Is
a
presentation
was
excellent
when
you
put
a
dollar
into
tobacco
prevention,
you
save
$20.
On
the
other
end,
when
you
put
a
dollar
in
to
immunization
and
now
we're
in
a
critical
period
around
immunization,
you
save
$16,
I.
Remember
all
those
budget
presentations
you
put
a
buck
in
now
and
you're
safe.
I
Sometimes
the
presentation
said
$8
$10
$12
at
the
other
end,
that's
what
we
need
to
keep
in
mind
here.
If
the
Ontario
government
was
smart
and
if
and
as
it
is
a
fiscally
very
conservative
government,
you
would
actually
do
the
reverse.
Therefore,
if
these
principles
are
accurate,
you
would
say
well,
maybe
you
well
using
their
language
and
their
way
of
thinking.
You
cut
on
the
curative
side
of
health
and
put
that
money
into
the
prevention,
because
it
actually
yields
better
results.
I
I
was
a
I've
been
the
chair
off
and
on
frankly
with
with
councillor
Fillion
for
the
last
27
years
here
in
the
city
of
Toronto
in
the
former
city
of
York,
the
biggest
event
that
marked
the
importance
of
those
insights
was
the
SARS
crisis,
and
you
may
remember,
people
may
remember
that
before
the
SARS
crisis,
the
funding
for
public
health
was
5050,
so
50%
came
from
the
province.
50%
came
from
the
city
and
dr.
nailers
evaluation
with
Sheila
Basra
people
might
remember
her.
I
They
we
came
up
with
the
province
with
an
understanding
that
that
had
to
change
that
public
health
was
so
important
that
the
new
funding
formula
was
7525,
that
the
province
did
not
want
cities
cheaping
out
or
being
tempted
to
save
money.
In
the
same
so
they
put
in
75
cent
dollars
to
make
sure
that
cities
and
municipalities
and
regional
municipalities
would
put
in
their
share.
That
was
for
the
protection
of
public
health
in
the
Ontario
system
and,
of
course,
that's
important.
I
Hundreds
of
thousands
of
people
aren't
smoking,
are
living
longer
or
living
higher
quality
quality
lives
because
of
the
work
that
we
we
did
and
we're
saving
the
system
money
same
thing
with
food
inspections,
the
restaurant
grading
system,
like
what
a
system
we
now
have,
one
of
the
world-class
dining
establishments
set
of
establishments
in
the
City
of
Toronto,
and
we
know
that
you
will
not
get
food
poisoning.
You
will
not
get
sick
from
the
food
that
you
you
eat
because
of
our
the
work
that
we've
done
on
that
system.
I
Vaccinations
herd
immunity
is
at
stake
with
some
of
the
diseases
that
are
around
flu.
Shots
like
a
flu
shot
today
saves
a
hospital
visit
tomorrow,
communicable
disease
control,
as
I
mentioned
before
nutrition,
seeing
food
also
as
medicine
curbing
type
2,
diabetes
and
all
kinds
of
other
illnesses.
So
what
do
I
think
we
need
to
do
of
course,
and
I
know.
I
It
is
of
one
piece:
Czar's
was
a
teaching
moment,
so
we
started
to
help
people
help
Torontonians,
tease
out
the
difference
between
what
you
folks
do,
and
what
the
hospitals
and
doctors
in
primary
and
acute
care
health
system
does.
This
is
a
teaching
moment
for
Toronto,
Toronto
and
Ontario
Torontonians
need
to
understand
the
value
of
public
health
and
how
it
is
really
integrated
into
keeping
their
life
strong
and
curbing
early
early
death.
I
So
I
would
say,
along
with
all
the
advocacy
moments,
maybe
there's
ways
that
we
can
find
use
this
also
as
a
teaching
moment
to
help
folks
understand
that
they
do
have
control
some
control
over
their
health
and
that
they
can
put
in
place
systems
to
make
sure
that
that
health
is
even
stronger.
That's
what
I
think
the
moment
calls
for.
Thank
you
very
much.
Mr.
chair
I.
I
J
Yes,
thank
you
very
much
mr.
chair
and
through
you
to
the
medical
officer
of
Health,
with
respect
to
the
proposed
cuts
to
trial,
public
health
and
all
public
health
budgets
across
Ontario.
I
know
that
we
obviously
are
standing
up
in
opposition
of
that,
and
the
chair
is
put
circulated.
Motion
outlining
our
opposition
can
I
ask
what
would
happen
if
we
are
not
able
to
reverse
those
cuts
exactly
what
services
are
we
saying
goodbye
to.
B
Right
through
the
chair
again,
we
don't
know
what
the
details
are
and
I
think
you've
heard
some
of
the
comments
from
the
deputies
that
have
presented
today
that
there
may
be
specific
methodologies
or
specific
plans
that
the
provincial
government
has
in
respect
of
how
those
cuts
are
meant
to
be
affected.
So
without
the
details,
it's
it's
it's
challenging
to
know
other
than
to
say
that
clearly
it
is
a
significant
impact
on
local
public
health
and
how
that
would
actually
be
manifest
has
yet
to
be
determined
and
so.
J
We
have
heard
about
the
the
lack
of
public
aware
so
the
the
public
awareness
campaigns
and
the
education
that
a
lot
of
public
health
does
with
respect
to
preventative
health
I
think
is
it
safe
to
assume
that
we
will
not
be
able
to
go
out
and
and
be
so
proactive
anymore.
I
know
that
you
don't
know
all
the
program
impacts,
but
I'm
just
curious
to
know
what
can.
Logically,
what
can
we
expect
to
see
so.
B
Through
the
chair
I
think,
logically,
we
can
expect
to
see
a
reduction
in
a
number
of
different
activities
across
Public,
Health
and
again,
depending
on
what
the
province
puts
forth,
whether
they're
specific
around,
which
which
we're
where
the
cuts
are
meant
to
be
affected.
How
these
I
think
that,
what's
referred
to
within
the
document,
the
budget
document
is
our
efficiencies
and
streamlining.
B
If
there
is
a
specific
line,
item
or
specific
areas
of
activity
that
they
wish
to
direct
those
cuts
towards
those
have
not
been
articulated
yet,
but
suffice
it
to
say
that
these
are
27%
for
twenty
six
point.
Six
six
six
repeating
I
believe
was
what
we
heard
is
a
significant
proportion
and
that's
not
a
simple
thing
to
absorb
and
do.
J
J
Recognizing
that
we
already
have
approved
our
2019
budget,
based
on
certain
probably
reasonable
assumptions
of
what
has
come
forward
in
the
previous
years
and
carried
forward,
is
there?
Is
there
the
opportunity
for
a
deeper
analysis
on
what
those
budgetary
impacts
will
be?
Even
if
we
don't
have
the
the
details
from
the
province
is,
that
is
that
work
that
your
team
will
be
undertaking?
So.
B
J
Recognize
that
there
are
literally
probably
hundreds
of
organizations
and
I
can
think
of
a
number
of
community-based
organizations,
nutrition
programs,
the
AIDS
service
organizations,
there's
the
there
are
hundreds
of
organizations
that
rely
on
grants
from
the
city
of
Toronto
and
and
those
dollars
may
not
necessarily
be
shared
by
the
province.
But
as
we
are
faced
with,
what
will
be
no
doubt
a
budget
shortfall
is
the
process
for
us
to
come
back
and
to
reevaluate.
J
And
finally,
my
question
around
just
coming
back
to
the
budget,
for
by
way
of
example,
will
a
possible
outcome,
and
this
year
be
at
the
Board
of
Health.
Coming
back
to
City
Council,
asking
City
Council
to
bridge
the
budget
shortfall
is
that
it
will
that
be
on
the
table,
because
once
we
once
the
money
is
evaporated
and
gone,
we
don't
want
to
lose
the
services
and
even
as
you
sort
of
rifle
through,
what's
a
priority
and
what's
not
you're
still
most
likely
will
still
be
short
will
be.
B
The
chair,
as
we
become
more
familiar
and
as
we
learn
greater
details
in
respect
of
what
the
budget
document
means
and
what
the
specific
implications
are
we'll
certainly
bring
that
forward
to
the
board.
However,
I
believe
it's
within
the
discretion
of
the
board,
and
that
will
be
the
board's
decision
to
make
whether
there
is
an
ask
of
City
Council.
Thank
you
very
much.
G
You
chair
dr.
to
the
lemon
ask
a
couple
of
the
questions
that
I
posed
earlier
with
respect
to
you
know
a
potential
alignment
with
the
health
system
change
in
the
number
of
health
units.
Can
you
describe
what
the
impacts
might
be
of
aligning
with
the
health
system
and
potentially
delinking
for
municipal
and
community?
Well,.
B
It's
through
the
chair,
it's
you
know
difficult
to
predict.
The
future
and
I
think
I've
learned
in
this
position
that
I
try
not
to
engage
in
prediction.
It's
a
complicated
game,
however.
I
think
we
can
look
at
the
experiences
of
other
jurisdictions
that
have
sought
to
align
Public
Health
or
include
public
health
and
more
closely
or
affect
a
closer
relationship
between
public
health
and
the
healthcare
system,
and
I
think
that
the
Deputy
dr.
Mowat
spoke
very
specifically
around
the
tyranny
of
the
acute
and
the
challenge
that
exists
there
in,
because
it
is
simply
a
question.
B
If
you
nature,
it
is
very
challenging
to
have
and
I
believe.
The
term
that
was
used
was
discipline
to
really
affect
those
resources
to
invest
those
resources
in
longer
term
solution,
solutions
that
are
requiring
investment
now,
not
an
expenditure,
but
an
investment
now,
but
don't
actually
provide
benefit
until
at
some
point
in
the
future.
But
I
would
put
to
the
board
of
health
that
it's
exactly
those
kinds
of
investments
that
create
health
within
the
context
of
a
give
me
a.
G
B
Through
the
chair,
the
short
answer
is
yes,
we
have
definitely
been
approached
and
are
engaging
with
other
partners
in
the
health
system.
We
do
see
that
there
is
a
continuum
of
care
right.
There
is
a
very
critical
role
to
be
played
by
the
healthcare
system,
whether
we're
talking
about
acute
care,
long-term
care,
primary
care
providers.
B
So
in
order
to
do
that,
we
need
to
have
those
connections
in
order
to
fulfill
all
our
roles
within
the
system.
We
have
to
have
important
connections
with
healthcare,
important
connections
with
community
agencies
and
other
municipal
partners,
and,
as
you
heard
from
some
of
the
deputies,
we
also
have
to
make
sure
that
we're
adequately
resourced,
that
we
have
the
expert
staff
who
have
the
capacity
to
diagnose
and
determine
those
issues
that
are
driving
health
needs
and
is
in
our
community,
and
that
are.
B
A
Thank
you
any
other
questions.
Seeing
none
I
have
just
a
few
I
just
want
to
understand
dr.
Davila,
your
position.
Building
on
your
presentation.
Is
it
correct
that
your
position
is
that
there
should
be
into
a
B
I?
Think,
there's
a
bit
of
feedback
on
my
mic
that
there
should
be
one
public
health
unit
in
the
City
of
Toronto
within
the
city
boundaries.
Sorry.
B
A
B
A
D
I
want
to
I
want
to
first
thank
the
people
who
came
and
made
deputations
here
today.
That
was
very
insightful
and
and
certainly
helped
me
clarify
my
think.
I
will
say
this,
though,
that
public
health
professionals
are
always
very
careful
and
very
measured
in
their
language.
I!
Guess
it's
because
they,
you
know
they
rely
on
an
evidence-based
approach
and
so
on
and
so
forth.
I'm
not
I'm
blunt
this.
D
This
is
not
a
savings,
it's
custom
and
it
will
mean
that
people
in
Toronto
and
Ontario
get
sicker,
and
it
will
mean
that
we
have
to
spend
more
money,
keeping
people
in
on
Gurney's
in
hock
in
hospital
corridors
and
hallways
and
that
there
will.
You
know
and
I
cannot
believe
that
anyone
would
ever
consider
this
in
the
province
of
Ontario,
where
the
last
time
there
were
cuts
to
the
system
that
protect
health
and
a
public
basis,
we
experienced
the
Walkerton
tragedy.
D
It
just
shocks
my
mind
that
this
would
be
on
the
table
and
I'll
tell
you
from
someone
who
spent
four
years
in
the
City
of
Toronto
government
grinding
through
detailed
budget
to
proposals
from
the
Board
of
Health
and
and
other
places.
You
can't
cut
a
quarter
of
the
budget
without
cutting
the
actual
delivery
of
services.
This
will
mean
fewer
frontline
health
care
workers
from
Toronto,
Public
Health,
giving
people
the
tools
to
stay
healthy.
It
will
mean
we
will
be
less
prepared
for
infectious
disease
outbreaks
or
other
health
emergencies.
D
It
is
just
madness,
and
it's
something
that
I
think
that
you
know
those
of
us
who
have
taken
the
time
to
volunteer
or
extend
our
duties
as
city
councilors,
to
sit
on
this
board
of
health
can't
stand
for,
and
it's
something
we
should
be
inviting
our
colleagues
at
other
boards
of
health
across
the
province
of
Ontario
to
stand
up
against
as
well.
I
can
think
of
very
few
things.
D
E
E
Think
all
I
want
to
go
to
a
restaurant
and
not
have
to
worry
that
it
hasn't
been
inspected
in
too
long.
That
I've
got
a
bring
a
bring
some
kind
of
tube
of
food.
For
my
children,
because
that's
the
that's,
the
only
thing
I
think
is
safe,
like
these
are
all
things
that
public
health
touches
on
on
a
regular
basis
and
like
if
the
government
wants
to
look
at
finding
efficiencies.
E
You
don't
you
don't
go
after
the
one
thing
that
delivers
on
efficiencies
and
savings
on
a
regular
basis
and
so
I,
like
I
I'm
pleased
to
support
the
the
motions
coming
forward,
but
but
friends,
we're
not
going
to
be
done
here
and
I
hope
that
what
what
this
committee
takes
home
and
anyone
watching
will
go
out
and
continue
this
dialogue
in
a
much
greater
greater
space
saying.
Why
would
the
government
so
willingly
put
all
of
us
and
all
of
our
kids
at
risk?
Thank
you.
Thank.
J
J
chair
for
doing
so,
and
also
to
the
the
deputy
for
coming
out
and
responding
so
so
eloquently
and
so
quickly,
I
recognize
that
there's
a
lot
of
information
we
just
don't
know
and
and
that's
why
I
believe
the
medical
officer
of
Health
gave
us
as
much
as
she
could,
but
recognizing
that
there's
a
lot
of
details
that
are
just
simply
not
there
which,
depending
on
the
mindset
that
you're
in
it,
could
lead
you
into
some
very
dark
places
of
what
can
go
wrong
and
I.
Think
of
all
the
things
that
can
go
wrong.
J
Toronto
Public
Health
and
the
agencies
that
work
with
Toronto
Public
Health
are
really
our
eyes
and
ears
in
the
community.
They
are
able
to
go
into
neighborhoods
and
work
with
vulnerable
populations
that
we
cannot
do
not
the
hospitals,
not
mainstream
big
health
organizations.
They
can't
get
there,
but
Toronto
Public
Health
can,
and
that
means
the
more
vulnerable
communities,
the
ones
who
are
further
outside
of
the
core
who
don't
have
access
to
the
mainstream
big
in
health
institutions.
J
They
are
on
the
grounds
working
with
those
communities
and
those
eyes
and
ears
are
absolutely
critical
and
that
feedback
loop
means
that
we
can
actually
have
a
fighting
chance
of
keeping
people
healthy
and
safe,
and
so
as
I
think
about.
As
my
mind
might
go
to
the
some
of
those
dark
places
of
what
happens.
If
we
don't
have
those
supports
and,
more
importantly,
what
happens
when
those
agencies
that
are
working
with
the
very
the
most
vulnerable
don't
have
support.
J
Really.
What
ends
up
happening
is
that
the
vulnerable
communities
don't
get
served
when
the
SARS
outbreak
hit,
the
city
of
Toronto
I,
remember
receiving
a
call
from
dr.
Sheila,
Barr.
Sure
I
was
the
president
of
the
Chinese
Canadian
National
Council.
At
that
time,
it's
a
human
rights
organization.
Why
were
we
getting
a
call
from
the
medical
officer
of
Health?
She
alerted
us
to
the
fact
that
there
was
discrimination
stigma
that
was
taking
place
in
the
community
that
certain
individuals
were
being
targeted.
J
J
I
think
is
a
testament
to
to
when
you
have
actors
and
players
and
on
the
ground
that
meant
that
it
was
not
going
to
affect
a
much
larger
population
and
we
saw
25,000
people
in
Toronto
being
quarantined
just
by
way
of
transatlantic
flights.
The
death
of
44
individuals,
including
Tecla
Lin,
who
is
a
personal
friend
of
the
family,
who
was
a
registered
nurse
and
then
Neela
larosa.
J
It
could
have
been
so
much
worse
and
and
in
other
places
it
was
worse
and
in
Toronto
there
was
a
rapid
response
and
the
the
strength
of
Public
Health
at
that
particular
point
in
time.
I
would
say,
was
probably
on
on
display,
and
so,
if
we
are
going
to
be
expressing
our
opposition
to
this
and
I
appreciate
that
the
language
can
only
be
so
strong
on
the
motion.
But
we're
going
to
have
to
follow
this
up
with
organizing
and
activity
and
just
like
the
100,000
students
came
out
of
high
schools
at
Queen's.
Park.
J
We're
gonna
have
to
figure
out
how
to
mobilize
the
hundreds
of
organizations
that
we
work
with
through
public
health
so
that
they
also
recognize,
and,
of
course,
they
already
do
how
to
move
that
together.
So
we
can
show
the
same
opposition
because
lives
are
at
stake
and
harm
will
be
done
if
these
cuts
are
allowed
to
carry
forward
and
go
through.
Thank
you.
A
Thank
You
councillor
wrong
Tam
any
other
speakers.
Okay,
seeing
none
I
will
begin.
Let
me
begin
by
placing
a
motion
that
is
being
advanced
circulated
and
the
motion
very
clearly
calls
on
the
Board
of
Health
and
City
Council
for
Toronto
City
Council
to
first
inform
us
to
affirm
our
support
for
Toronto
Public
Health,
both
for
the
mandate
of
Toronto
Public
Health,
and
for
the
funding
to
oppose
the
cuts
that
have
been
brought
forward
by
the
provincial
government,
both
to
the
number
of
public
health
units
across
the
province,
as
well
as
to
funding
and
I.
A
Think
importantly,
as
well
to
work
with
the
association
of
public
health
agencies
in
Ontario
to
ensure
that
this
is
not
simply
about
our
city
and
our
borders
in
our
residents.
It
is
also
about
the
health
and
well-being
of
the
residents
of
this
province,
and
this
is
to
formally
state
our
intention
to
work
with
the
association
of
public
health
agencies
to
stand
together.
I
thought
dr..
Mowat
put
it
quite
well
when
he
alluded
to
the
cycle.
A
The
cycle
whereby
a
reduction
in
funding
leads
to
an
emergence
of
outbreaks
and
infectious
diseases
which
leads
to
the
public
calls
for
action
leading
to
the
restoration
of
funding.
It's
short-sighted
and
we've
seen
this
tale
before
when
we
called
this
special
meeting
of
the
Board
of
Health
to
take
place
today,
we
anticipated
that
there
might
be
something
in
the
budget
we
had
to
respond
to
I.
A
A
And
so
when
we
called
this
meeting,
I
anticipated
that
we
might
have
to
respond
because
the
health
of
Ontarians
may
be
at
risk,
I
did
not
expect
that
they
would
be
at
serious
risk,
but
that's
where
we
stand,
and
so
we
will
work
together
both
as
this
board
but
with
34
other
boards
right
across
the
province
to
raise
our
collective
voices
and
make
sure
that
these
cuts
don't
proceed
with
that.
I
think
will
call
for
a
vote
and
I'd
ask
for
a
recorded
vote
on
this.
Please.