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From YouTube: Board of Health - December 9, 2019
Description
Board of Health, meeting 12, December 9, 2019
Agenda and background materials:
http://app.toronto.ca/tmmis/decisionBodyProfile.do?function=doPrepare&meetingId=15409
Meeting Navigation:
0:07:59 - Call to order
1:34:17 - Meeting resume
Agenda Items:
0:12:43 - HL12.1 - ChemTRAC 2018 Reporting (Ward All)
0:10:13 - HL12.2 - Ontario Public Health Standards Risk Management Reporting for 2019 (Ward All)
0:23:09 - HL12.3 - Update on Aerosolized Liquid Products (Vapour Products) (Ward All)
1:36:41 - HL12.4 - Toronto Public Health Organizational Review (Ward All)
0:10:41 - HL12.5 - Audit Committee Item AU4.9 - Auditor General's Office 2020 Work Plan (Ward All)
2:23:49 - HL12.6 - Ministry of Health Discussion Paper on changes to Public Health in Ontario (Ward All)
2:25:35 - HL12.7 - Anti-Black Racism Training (Ward All)
A
A
So
welcome
to
meeting
12
the
Board
of
Health
look
welcome
to
members
of
the
board
and
to
members
of
the
public.
You
can
follow
the
agenda
and
debate
on
your
computer
tablet
or
smartphone
at
WWDC
a
slash
council.
The
Board
of
Health
acknowledges
the
land
we
are
meeting
on
is
the
traditional
territory
of
many
nations,
including
the
Mississauga's
of
the
credit,
the
Anishinaabe,
the
Chippewa,
the
hona
shown
a
and
the
one
dat
peoples
and
is
now
home
to
many
diverse
First,
Nations,
Inuit
and
métis
people's.
We
also
acknowledge
that
Toronto
is
covered
by
treaty.
A
Thirteen
with
the
Mississauga's
of
the
credit
before
we
begin.
First
of
all
can
I
thank
vice
chair
long
Tim
for
stepping
into
the
chairs
shoes.
Last
meeting
when
I
was
off
taking
care
of
a
newborn
I
appreciate
it
greatly.
Are
there
any
declarations
of
interest
under
the
municipal
conflict
of
interest
to
act,
trustee
Locke
ready?
Do
you
want
to
declare
your
interest
I?
Didn't.
B
A
So
when
we
come
to
that
item,
we'll
ask
you
to
step
out
of
the
room
and
we'll
do
a
recorded
vote
and
you
can
hand
the
form
over
declaring
your
conflict.
The
clerk's
I
have
a
motion
can
with
for
a
confirmation
of
the
minutes
from
November
the
12
2019
moved
by
director
perks,
all
those
in
favor
opposed
if
any
that
is
carried.
A
You've
had
some
communications
presented
here
in
front
of
us
as
well.
On
the
green
sheet,
you'll
see
a
list
of
people
here
to
depute.
Today,
if
you
are
a
member
of
the
public,
and
you
would
like
to
speak
kindly
come
over
to
clerks
the
lovely
folks
on
my
right
and
you
can
register
we're
now
going
to
go
through
the
yellow
sheets
item
HL
just
to
do
the
agenda
order,
item
HL,
12.1,
chem,
track
2018
reporting
held
down
for
council
perks,
all
right
item,
HL,
12.2,
Ontario,
public
health
standards,
risk
management,
reporting
for
2019.
A
All
those
in
favor
pose
many
of
that
carried
it
have
met.
Some
men
do
I,
do
need
to
do
item
s
a
minute.
No,
no
right!
So
that's
taken
care
of.
We
have
two
new
business
items.
Do
they
need
to
be
introduced?
Yes,
they
do
so
we
have
on
the
pink
sheets
two
items,
one
from
myself.
This
is
with
regard
to
the
ministry
of
health
discussion
paper
and
changes
to
public
health
in
ontario
like
to
move
to
introduce
that
item.
A
All
those
in
favor
opposed
pending
that
added
and
one
from
director
perks
regarding
anti
black
racism,
training,
adding
that
item
to
the
agenda
director
perks,
all
those
in
favor
opposed
any
carried
all
right.
So
that's
the
agenda
in
front
of
us
I'm
gonna
do
one
small
shift
today
and
you'll.
Forgive
me
I.
This
is
the
the
Board
of
Health,
but
I
have
a
brutal
head
cold
and
I
am
in
a
literal
fishbowl
at
the
moment,
so
I've
asked
Vice
Chair
long
Tam
to
sit
in
the
chair
seat.
C
D
E
F
You
very
much,
madam
chair,
so
through
you
to
the
medical
office
of
Health.
What
are
the
consequences
for
the
other
ten
organization
that
did
not
complete
the
audit,
because
you
indicated
in
the
report
that
88%
of
them
completed
the
audit?
What
happened
to
the
12
percent
and
what
are
the
concept
I'm
not
complying?
So.
E
E
F
My
follow
up
question,
madam
chair,
is
that
are
these
same
ten
companies
who
are
what
I
call
habitual
non-compliant?
Because
if
you
have
data
this
past
year,
they
have
not
been
in
compliance.
Are
they
in
non-compliance
previous
years,
because
it
is
so
critical
when
we
have
legislature
by
law?
That
is
for
everybody
that
these
ten
company
chose
not
to
compliance
and
what's
the
purpose
of
a
bylaw,
when
you
just
told
them
that
you're
not
in
compliance
and
there
are
no
consequences
so.
E
G
Through
the
chair,
the
groups
that
you're
referring
to
the
medical
affairs
correct,
they
are
being
supported
to
come
into
compliance.
Sometimes
it's
a
matter
of
calculations.
The
way
their
data
has
been
presented
and
calculated
needs
to
be
reassessed.
Sometimes
it's
a
matter
of
the
company
understanding
that
the
information
will
be
made
publicly
available,
and
that
is
the
way
this
particular
bylaw
functions.
Knowing
that
there
will
be
a
public
reporting
at
the
end
of
the
process
brings
companies
into
compliance.
Thank
you.
C
D
E
C
E
Through
the
chair,
this
actually
came
from
a
motion.
It
counts.
There
were
some
concerns
that
were
raised
by
local
residents
in
respect
of
odors
and
that
which
was
being
produced
or
felt
to
be
being
produced
by
local
industry.
So
this
came
forward
through
Council.
There
were
a
number
of
different
directions,
some
of
which
we
were
involved
with
as
Toronto
Public,
Health
and
others
of
which
were
more
under
the
purview
of
other
city
divisions.
Oh
I,.
C
E
G
The
chair
and
then
I'll
ask
if
the
others
that
have
worked
on
this
one,
a
tagging.
So
we
do
this
review
as
part
of
the
program
annually
and
do
the
annual
report
as
part
of
doing
the
annual
report.
We
included
within
Ward
5
the
facilities
who
are
required
to
report
based
on
the
materials
that
they
use
and
whether
they
reach
certain
threshold.
So
we
followed
the
process
that
we
would
normally
go
through.
It
included
Ward
5,
so
we're
bringing
a
combination
report.
B
The
chair
just
to
add
to
that
so
as
part
of
our
regular
process,
we
always
audit
a
sample
of
facilities
across
the
city,
so
we
typically
audit
around
10%
of
facilities
this
year
because
of
the
requests
from
canceled
council,
we
did
sort
of
over
sample
into
Ward
5
to
audit
a
few
more
of
those
facilities
too.
In
order
to
adequately
respond
to
the
requests
from
City
Council.
Ok,.
C
B
So
of
the
facilities
where
we
found
errors
in
the
through
the
audit
process,
only
one
had
a
significant
error,
which
was
that
they
should
have
been
reporting
and
weren't.
That
is
called
Bank
brothers
and
Sons.
The
other
facilities
were
what
we
call
insignificant
errors,
so
it
might
didn't,
have
been
and
sort
of
a
problem
with
the
naming
of
the
facility
or
something
similar
to
that
all.
C
B
B
C
Okay,
seeing
none!
The
recommendation
before
us
is
to
receive
this
report
for
information
who
is
interest
in
moving
that
director
Crescent?
Okay,
all
those
in
favor
Oh.
Actually,
we
do
in
because
I
think
director
Mulligan
had
declared
an
int
okay,
frosty
lip
Freddie's
declared
a
conflict.
We
do
need
to
need
to
move
to
a
recorded
vote
and
I
will
ask
the
clerk's
to
call.
B
So
all
in
favor
of
the
the
motion
to
receive
for
information,
ash,
nebari,
Stephanie,
Donaldson,
Angela,
Johnson
Cynthia
lie
Mike
Layton,
Joe,
Cressy,
Kristyn,
wong-tam,
Jennifer,
McKelvey,
Kate,
Middleton,
Kate,
Mulligan,
councillor
perks,
Peter,
Wong
and
tsuyama
thinking;
okay,
any
opposed.
Okay,
that
curious,
hey.
C
Thank
you
very
much,
okay,
so
we're
moving
on
to
item
number
two
and
item
two
I
believe
has
already
been
adopted,
so
we're
moving
on
to
item
number
three.
We
do
have
some
speakers
on
item
number
three:
we
have
a
presentation
staff
first
update
on
aerosolized
liquid
products,
vapor
products
and
we
have
a
presentation
from
staff.
G
Good
morning,
this
is
a
presentation
on
vapor
products
or,
as
we
have
called
them
through
this
report,
aerosolized
liquid
products.
By
way
of
background,
this
report
responds
to
the
medical
officer
of
health
that
requests
the
medical
officer
of
health
in
September
to
report
back
on
the
health
impacts
of
vaping
products,
as
well
as
potential
actions
for
government
vaping
products
can
be
defined
as
the
vapor
or
what
has
been
inhaled
by
a
user
which
comes
from
the
heating
of
liquids
to
produce
an
aerosol.
G
We
wanted
to
be
specific
about
this
definition,
because
there
are
vaping
products
available
commercially
that
are
benign.
These
products
are
anything
but
benign,
so
these
aerosolized
liquid
products
are
also
known
as
a
cigarette
or
vaping
products,
but
we
use
that
term
throughout
the
report
to
point
out
that
there
is
a
risk
associated
with
them.
Looking
at
the
next
slide,
there
are
both
short-term
and
long-term
health
risks,
Health
Canada
and
many
other
health
organizations
who
advise
that
the
long
term
health
impacts
of
vaping
products
or
aerosolize
liquid
products
are
not
yet
fully
known
to
date.
G
What
is
known
is
that
these
products
can
expose
users
to
multiple
chemicals
that
are
associated
with
health
harm.
Many
of
these
products
contain
nicotine,
which
is
an
addictive
substance
and
is
associated
with
adolescent
brain
development
harm.
There
are
also
associations,
once
someone
begins
vaping
with
the
beginning
of
smoking
cessation,
so
tobacco
smoking
not
cessations
tobacco
smoking,
and
this
final
point
is
particularly
concerning
to
the
public
health
community,
because
some
of
the
best
gains
we've
made
within
public
health
have
been
the
reversal
of
the
use
of
tobacco.
G
So
we're
concerned
about
how
things
have
changed
on
the
landscape,
with
this
particular
issue
of
aerosolized
vaping
paralyse
liquid
products
looking
at
youth
use,
so
here
we're
talking
about
teenagers
as
well
as
those
in
their
early
20s
we've
seen
incredible
increases
in
vaping
use
among
this
group.
National
surveys
will
show
increases
looking
at
particular
years,
such
as
between
2017
and
2018,
where
there
is
a
greater
than
70%
increase
in
the
use
of
bathing
products.
G
Recent
data
that
we
have
gathered,
even
since
this
presentation
was
developed,
show
in
the
Ontario
tobacco
use
monitoring
survey
that
vaping
among
high
school
students
has
almost
doubled.
So
when
you
look
at
2013,
around
15
percent
of
high
school
students
were
vaping.
Now
in
2017
we
see
29
percent
of
students,
vaping.
G
G
We
also
see
large
advertising
campaigns
throughout
the
city,
billboards,
print
ads,
pop-up,
promotional
events,
social
media
all
contain
promotion
around
the
use
of
vaping
products.
We're
in
the
report.
We
commend
provincial
government
for
as
of
January
2020,
removing
advertising
that
was
previously
permitted
in
resale
stores
where
youth
and
children
access,
but
we're
asking
this
report
in
this
report
for
there
to
be
even
stronger
measures
to
remove
the
promotion
of
vaping
products,
a
final
areas
flavors.
G
So
the
flavours
that
vaping
products
are
available
in
are
numerous
and
they
mimic
confection
products
pop
and
other
flavors
that
make
it,
as
we've
heard
in
studies
done
with
youth
in
particular,
are
appealing
to
youth
and
are
part
of
the
reason
they're
curious
about
using
bathing
products.
So
flavors
definitely
play
a
role
and
that's
why
one
of
the
recommendations
we're
bringing
forward
relates
to
flavors.
So
the
recommendations
are
in
three
main
areas.
G
The
first
is
to
the
federal
government,
where
who
are
responsible
for
the
manufacturing
of
the
ingredients
and,
to
a
certain
extent,
sales
of
vaping
products,
we're
asking
for
a
prohibition
on
the
advertising
and
promotion
of
aerosolized
liquid
products
anywhere
or
minors
have
access.
So
this
means
that
we
would
be
limiting
the
advertising
justice
stores
that
adults
access,
which
are,
for
the
most
part,
specialty
vape
products
stores.
It
sells
specialty
vape
products,
we're
also
asking
for
a
prohibition
on
the
sale
of
flavors,
so
that
they're
only
available
where
mine
don't
have
access.
G
Secondly,
we
are
asking
the
government
Ontario
to
within
the
smoke
free
Ontario
Act
prohibit
the
sale
of
flavors.
This
is
in
addition
to
the
federal
government,
because
it's
so
important
that
we
get
in
front
of
this
issue.
So
there
can,
within
their
jurisdiction
that
province
can
limit
the
sale
of
flavours
to
just
stores
that
are
accessible
by
adults,
so
that
would
take
them
out
of
all
of
the
common
areas
that
youth
can
go
to
gas
stations
and
convenience
stores
etc.
G
Finally,
we're
looking
locally
to
see
where
vaping
can
occur
and
make
it
match
the
legislation
we
have
now
or
that
bylaw
we
have
now
within
our
ability
to
legislate
on
tobacco,
smoking
so
and
currently
vaping
is
not
allowed
within
bars
and
restaurants,
but
are
under
the
provincial
legislation
but
locally
through
a
addition
to
the
tobacco
bylaw.
We
can
limit
vaping
in
places
such
as
the
entrances
to
public
buildings,
so
have
the
nine
meters
away.
We
can
also
look
at
park
amenities
and
ensure
that
vaping
is
not
allowed
there,
where
it
currently
is.
G
And
finally,
what
we're
looking
at
in
general
is
a
harmonized
approach
from
all
three
levels
of
government
to
really
get
in
front
of
this
health
risk.
These
recommendations
are
particularly
important
as
I
mentioned
for
youth,
because,
in
addition
to
the
health
risks
associated
with
vaping,
youth
are
at
risk
of
becoming
addicted
to
nicotine
and
we've
seen
the
beginning
of
tobacco.
G
C
You
very
much
for
the
presentation.
We
do
have
some
speakers,
so
perhaps
so
what
we
can
do
is
actually
invite
the
members
of
the
public
to
provide
us
with
their
deputation
and
then
we'll
invite
staff
back
to
answer
questions.
Our
first
speaker
is
Gary
Thompson
Gary.
Are
you
here
nice
to
see
you
thank
you?
You
want
to
come
up
and
choose
one
of
the
chairs
and
I'll
turn
on
your
time
when
you're
ready.
H
Like
preaching
the
gateway
drug
effect,
I
thought
that
went
away
like
the
dodo
bird
trauma,
stress
and
human
nature
to
see
altered
consciousness
are
causes,
I
was
live.
A
kmh
webinar
Youth
and
vaping
November
28th
quote:
panelist
Peter
Selby
acute
lung
injury.
When
the
USA
looked
at
the
data,
more
than
80%
of
cases
were
from
illicit
ly,
purchase
cannabis
products.
H
H
Mental
health,
consumers
and
staff
use
tobacco
or
vaping.
As
a
stress,
reliever
policy
causes
more
stress.
They
find
a
way
to
break
the
rules
or
seek
other
forms
of
stress,
release
more
problematic
when
the
medical
profession
fails
to
follow
the
moral
codes.
First,
two
nor
no
harm
sure
sign.
The
civilization
is
crumbling
painfully
cognitive,
dissonance,
lighting,
ourselves
and
others
to
protect
a
core
belief,
medical
profession,
etc.
Does
not
willfully
cause
harm.
H
H
Swimming
lesson:
grab
20
pound
rock
jump
in
the
pool
hold
on
37
point,
5
million
Canadians.
Still
at
the
bottom
years
later
a
child
knows
breathe
or
died.
This
is
from
the
front
page
of
the
Toronto
Star
today,
a
veterinarian.
Any
animal
suffers
a
respiratory
emergency
to
give
respiratory
assistant
and
I
notice
coming
into
the
square.
Today
that
the
city
is
supporting
epilepsy
for
the
holiday
season,
I've
had
to
pull
a
parent
off
their
child,
giving
chest
compressions
to
an
epileptic
seizure
patient.
C
I
Vaping
among
youth
is
what
I
would
call
an
epidemic.
The
statistics
are
there
in
2017.
It
was
up
to
29
percent
of
our
youth,
none
of
them
old
enough
to
vape
our
vaping
and
the
statistics
continue
to
go
up
when
I
became
aware
of
this
I
did
something
that
is
truly,
not
scientific
but
still
invited
me
I,
put
it
on
social
media
and
said:
ask
any
seventeen
year
old.
You
know
how
many
of
their
peers,
vape
and
I
just
put
it
out
there
on
social
media.
The
answers
that
came
back
blew
me
away.
I
I
would
get
answers
five
out
of
six
most
of
the
kids
80%
of
us
vape
and
it
went
on
and
on
when
I
go
and
I
do
go
for
the
civics
class
I
go
into
high
schools
and
I
will
ask
the
kids
right
there.
How
many
of
us
have
try
vaping
80%
of
the
hands
go
up
and
then
I
would
go
a
step
further
and
ask
how
many
of
you
vaped
yesterday,
just
you
know
to
put
it
in
perspective?
I
Is
it
something
and
over
half
of
the
hands,
go
up
a
lot
of
our
kids
vape
so
with
the
Canadian
Cancer
Society,
with
Heart
and
Stroke,
with
many
allies
in
the
healthcare
field,
I
put
a
bill
forward.
The
bill
does
six
thing.
The
first
thing
is
that
it
bans
advertising
the
same
level
of
banner
advertising
that
we
have
on
tobacco
would
be
brought
forward
to
vaping
know
supporting
clubs
know
online
advertising.
No
advertising
period
then
limit
the
flavors.
I
It
would
allow
prescribe
flavors
as
in
if
we
find
a
flavor
that
really
help
smokers
quit
and
I
doubt
that.
But
if
we
do,
then
those
flavors
would
be
prescribed
otherwise,
no
limit.
The
nicotine's
we
all
know
that
young
person's
brain
gets
addicted
to
nicotine,
pretty
quick.
The
Cancer
Society
talks
about
twice
this.
This
try,
vaping
twice
with
the
high
level
of
nicotine
and
the
kids,
are
addicted.
What
good
comes
of
having
50
percent
of
our
kids
addicted
to
nicotine?
Nothing
good
comes
of
that.
I
So
six
things
that
I
realize
have
all
been
talked
about
this
morning,
but
the
one
that
you
can
affect
really
quickly
and
could
have
a
huge
impact
is
advertising
when
I
and
many
other
Cancer
Society
onto
your
coalition
against
tobacco
physicians
for
folks
me
smoke-free,
Canada,
etc.
Ask
the
kids
why
this
debate?
The
first
reason
is
that
it
tastes
good.
The
second
reason
is
kind
of
putting
it
back
to
us
that
if
it
was
dangerous,
if
it
was
not
good
what
the
government
would
do
something
about
it,
you
wouldn't
see
it
advertised
everywhere.
I
You
it
wouldn't
be
so
available
everywhere.
Oh
and
I
forgot
to
mention
in
the
bill
vaping
would
be.
The
cell
of
vaping
would
be
limited
to
specialty,
vaping
stores.
So
that's
it!
That's
all.
You
would
not
be
allowed
to
come
into
those
stores.
Unless
you
are
19
years
old
and
that's
the
only
place
you
could
buy
vaping
products,
no
more
corner
store,
no
more
making
it
available.
So
I,
really
you
are
the
cream
of
the
crop
when
it
comes
to
public
health.
I
You
have
set
policies
before
that
many
others
in
Ontario
follow
I,
encourage
you
to
show
your
leadership
against
today
and
put
forward
a
vote
for
emotions
that
will
ban
advertising
in
everything
that
is
under
your
control.
You
will
set
an
example
for
other
health
units
and
other
boards
of
health,
but
you
will
also
protect
thousands
and
tens
of
thousands
of
youth
from
becoming
addicted
to
nicotine,
and
my
five
minutes
is
over.
C
I
Absolutely
so
taxations,
we've
known
through
the
work
on
tobacco
that,
as
you
increase
the
price
it
has,
the
major
effect
is
on
youth,
is
on
youth,
picking
up
the
habit,
as
well
as
on
youth,
continuing
to
use
the
products,
but
second,
is
that
this
extra
revenue
will
fund
research,
because
what
we
hear
an
awful
lot
is
that
a
vaping
is
good
to
quit
smoking.
There
is
no
body
of
evidence
that
shows
this.
It
shows
that,
although
there
isn't
there
is
no
body
of
evidence.
Why?
I
Because
there
is
no
money
available
to
do
the
work,
to
build
that
body
of
evidence.
So
taxation
works.
For
me,
it's
a
win-win.
It
works
at
discouraging
news
from
picking
up
smoking
and
it
gives
us
the
resources
so
that
good
people
like
you
at
the
Board
of
Health
can
do
the
work
and
have
the
resources
to
do
the
work
to
to
show
the
real
impact
of
vaping
on
our
youth
and
on
society
in
general.
Thank
you.
J
To
you,
madam
chair,
first
of
all,
thank
you
so
much
for
all
your
work
as
health
critic
at
the
province
and
thank
you
for
all
your
work
on
this
bills.
Very
much
appreciated
as
a
trustee
of
the
TDSB
I
can
attest
that
this
is
absolutely
an
epidemic.
A
huge
problem
in
our
school
and
our
youth
are
really
suffering
because
of
it.
So
I
just
have
a
question
for
you
in
terms
of
the
work
that
you
did
to
prepare
this
bill
is:
has
legislation
been
enacted
in
other
provincial
jurisdictions
similar
to
yours,.
I
Yes,
so
we
had
British
Columbia,
who
came
forward
and
regulated
the
vaping
industry
as
well
as
have
Nova
Scotia
who's.
Also
moving
forward
with
regulating
vaping
Quebec
started
to
move
in
that
direction.
It
hasn't
reached
the
finish
line,
but
they
are
moving
in
that
direction
and
I
would
say
just
touching
base
with
Alberta
and
Manitoba
I
I
haven't
heard
anything
from
Saskatchewan,
but
Alberta
in
Manitoba
are
both
also
interested
in
moving
forward.
I
So
you
can
expect
to
see
movement
at
the
provincial
level
in
a
number
of
jurisdiction,
but,
as
I
said,
you
carry
a
lot
of
weight.
What
you
do
as
Toronto
Board
of
Health
is
looked
upon,
and
not
only
do
you
have
an
opportunity
to
help
your
constituents,
but
it
would
also
help
us
at
the
provincial
level
and
outside
of
your
borders.
J
I
Similar
to
what
the
previous
speaker
talked
about,
the
main
impetus
for
the
states
to
declare
public
health
emergency
was
because
of
the
death
that
have
occurred
because
some
of
the
substances
are
banned
in
Canada
and
because
really
we
haven't
got
the
strong
body
of
evidence
to
show
death.
But
to
me
that
is
the
tip
of
the
iceberg.
It's
everybody
else.
When
asthma,
aunty
asthma,
Canada
came
to
the
press,
release
to
the
press
conference
and
talked
about
the
number
of
kids
that
show
up
with
asthma
related
illness,
and
then
they
realized
the
kid
doesn't
have
asthma.
I
But
this
is
not
enough.
It
is
for
every
other
person.
Who's
had
a
health
issue,
who's
the
head
breathing
issue,
because
none
of
this
is
being
captured.
So
again
we
haven't
got
the
data
to
say
this
is
a
public
health
emergency.
We
could
I
think
be
used
the
precautionary
principle
and
say,
while
we
don't
know
enough,
we
should
but
right
now
the
government
is
not
interested
in
that.
Thank.
B
You
MPP
chilliness
for
coming
today
as
a
pediatrician
I.
You
know
we
certainly
support
the
work
that
you're
doing
in
the
legislature.
My
question
for
you
is
that
this
is
a
private
member's
bill.
How
far
along
in
the
process,
are
we
and
do
you
foresee
any
barriers
to
this
becoming
law
and
about
how
long
do
you
think
this
might
take
to
actually
come
into
effect
so.
I
I
I've
been
in
the
business
for
12
years,
I've
been
the
health
credit
for
12
years.
I,
don't
give
people
false
hope
right
now,
since
the
Ford
government
has
been
in
power,
zero
private
member's
bill
has
come
forward.
I
have
never
seen
this
before.
In
every
years
that
I've
been
there.
There
has
always
been
private
member's
bill
that
have
come
forward.
I've
had
numerous
private
member's
bill
come
forward
right
now,
with
the
provincial
government
we
have
in
place.
I
would
give
it
be
giving
you
false
hope.
I
If
I
say
that
that
I'm
hoping
that
by
such
a
date,
it
will
become
law,
but
a
private
member's
bill
don't
only
become
law,
it
brings
forward
a
conversation,
it
forces
a
conversation
and
whenever
I
see
other
people
joining
into
that
conversation,
I
encourage
you
to
bring
your
voice
together
and
be
as
loud
as
we
can.
We
live
in
a
democracy.
The
government
will
have
to
listen,
but
it
will
take
a
lot
of
goodwill
from
a
lot
of
people
to
get
to
the
finish
line.
Thank.
C
C
Are
there
any
other
members
of
the
public
here
to
speak
to
this
particular
item?
Seeing
none,
then
what
we'll
do
is
turn
this
inside
and
start
to
ask
questions
of
staff
of
those
members
who
have
questions
of
staff.
Please
indicate
okay,
a
director
Wang,
then
director
Donaldson
and
director
Pressy.
Thank.
F
You
very
much
madam
chair,
so
I
do
have
a
lot
of
questions
with
a
great
report.
I
just
want
to
get
some
clarification.
I
noticed
through
you,
madam
chair,
through
the
staff
that
there's
a
lot
of
references
to
the
lack
of
data,
and
we
heard
again
this
morning
from
MPP
gentlemen
about
the
lack
of
data,
yet
in
our
recommendation
as
a
board
that
there's
no
mentioning
about
research,
because
unless
we
get
the
federal
government
and
the
provincial
government
dedicated
resource
to
it,
so
I
just
want
to
ask
to
you,
madam
chair,
to
the
medical
staff.
F
E
Through
the
chair,
we
have
no
aversion
to
having
the
province
or
the
the
federal
government
undertakes
the
research.
We
do
know
that
our
research
partners,
universities,
post-secondary
institutions,
are
actively
engaged
in
this
issue
and,
in
fact,
some
of
the
data
that
are
out
there.
The
most
current
data
that
are
out
there
in
respect
of
youth
usage
are
coming
from
those
studies.
However,
there
are
sources
of
data
available,
whether
it's
tobacco
and
other
drug
use
amongst
students
more
broadly
in
the
population.
There
are
venues
to
get
that
information
to
help
inform
subsequent
research
efforts.
The.
F
Other
question
I
have
see
a
manager
to
the
medalist
of
health
with
regard
to
the
long
term.
Effects
is
their
like
again
on
a
big
leaflet.
Page
is
a
page
for
the
report.
It
talked
about
the
long-term
effects
affecting
and
there's
again,
not
enough
data
to
support
it.
Is
there
current
Canadian
data
to
address
this
issue,
because
without
data
we
can't
make
good
choices
and
decision
making,
so
is
there
sufficient
resources,
both
federally
and
provincially,
to
address
this
issue
so.
E
Through
the
chair,
to
be
honest
with
you,
I'm,
not
certain
as
to
what
resources
are
available
at
the
federal
and
the
provincial
level
to
do
that
kind
of
research,
however,
and
I'll
ask
my
staff
to
correct
me
by
if
I
misspeak
on
this.
My
understanding
is
that
the
products
haven't
really
been
generally
available
since
about
its
2013
was
when
we
really
started
having
products
available
on
the
Canadian
market
and
Nick
regulations,
and
therefore
broader
availability
of
e-cigarettes
and
other
similar
products
didn't
happen
until
2018.
E
So
the
issue
around
data
on
long
term
effects
has
to
do
with
the
fact
that
there
actually
has
to
be
long
term
use
of
the
product
to
understand
what
the
long
term
health
effects
are.
We
do
have
some
senses
to
the
short-term
effects
and,
in
fact
we're
seeing
some
of
those
things
play
out
in
the
United
States,
but
to
my
staff.
Anything
further
that
I've
missed
through.
G
The
chair,
that's
correct.
The
usage
has
increased
a
lot,
but
in
a
very
recent
last
few
years
the
confirmed
cases
within
Canada
are
13,
there
haven't
been
deaths,
and
this
is
work
that
the
province
and
the
feds
are
keeping
a
very
close
eye
on.
But
there
are
various
thresholds
and
categories
that
need
to
be
met
for
them
to
move
forward,
so
they
are
monitoring.
What
we're
doing
here
is
saying
that
the
three
levels
of
government
who
can
do
things
related
to
availability,
flavors
and
where
you
can
vape
need
to
come
up
and
provide
that
policy.
F
Thank
you,
the
other
question
I
have
is.
We
also
heard
it
this
morning
from
MPP
gentleman
about
the
issue
of
young
people
and
vaping
product,
so
I
present
in
this
province
in
the
city.
Do
we
have
dedicated
resources
to
do
comprehensive
education
and
awareness
targeting
young
people,
because
this
is
not
a
product
for
seniors?
Like
me,
okay,
let's
call
the
way
it
is
so.
My
question
is
to
you,
madam
chair,
to
the
Medicus
of
health.
Do
we
have
dedicated
resources
right
now
to
address
this
emerging
public
health
concerns
attacking
young
people
o.
E
Through
the
chair,
we
do
have
some
resources
dedicated
towards
this.
However,
as
the
report
indicates,
and
as
we've
heard
from
MPP
jelena,
there
is
a
significant
amount
of
advertising
and
promotion,
and
we
also
heard
through
the
presentation
that
there
are
various
events,
including
pop-up
events,
that
are,
you,
know,
encouraging
and
actively
promoting
use
of
these
products
amongst
youth.
That
is
a
you
know,
something
that
can't
be
addressed.
One
on
one
I
actually
think
the
policy
solution
that
we're
proposing
here
through
this
report
is
exactly
what's
needed
to
address
that.
So.
E
G
The
chair,
so
as
the
middle
class,
our
health
mentioned,
we
are
mandated
to
do
work
on
tobacco
and
vaping
youth
prevention,
and
we
have
a
very
active
group
of
youth
who
are
noted
in
the
report.
On
page
seven,
the
youth
Action
Network,
who
have
been
working
at
a
policy
level
in
addition
to
education
with
their
peers,
to
get
some
of
the
types
of
policy
initiatives
there
in
the
three
recommendations
through
and
they
had
they
recently
in
October,
held
an
event
that,
if
I'm
understand
it
was
right
here.
G
I
think
at
City
Hall
to
bring
awareness
to
this
issue
and
I
think
they
are
a
very
powerful
message:
conveyor
as
peers
to
the
folks
that
we're
working
to
influence
so
that
we
definitely
are
working
tightly
with
youth
to
influence
their
peers,
but
they're
working
with
us
to
influence
the
policy
change.
So.
J
3:00,
madam
chair,
thank
you
for
the
great
report.
I
know
the
position
statement
in
the
section
under
nicotine
content.
It
says
that
since
vapor
products
containing
nicotine
became
legal
in
Canada
in
2018,
nicotine
concentrations
available
had
increased
from
approximately
two
percent
or
lower
to
five
percent.
How
is
it
possible
that
that
happened
so.
E
E
Through
the
chair,
this
is
a
method
by
which
to
actually
more
height,
to
heighten
the
capacity
of
nicotine
to
be
delivered
through
these
particular
devices.
So
you
know
in
respect
of
delivering
nicotine,
it
was
found
a
through
research
that
this
was
a
very
effective
method
to
deliver
nicotine
into
the
system
via
e-cigarettes
and
other
similar
products,
and.
E
Through
the
chair,
I
think
there
are
a
couple
of
things
you
get
a
large
dose
of
nicotine
in
a
relatively
short
period
of
time.
Add
to
that
that
nicotine
is
a
highly
addictive
substance
and
particularly
so
for
the
developing
brain
and
I.
Think
you
have.
You
know
a
very
dangerous
combination
as
a
result
which.
J
E
The
chair,
there
isn't
a
particular
threshold
per
se
and
it's
difficult
for
me
to
speak,
to
Health
Canada's
intentions
or
how
they
judge
circumstances,
but
I
would
say
writ
large.
There
isn't
a
particular
threshold
for
in
I
experience
and
and
and
having
observed
that
which
Health
Canada
does
they
I
believe
seem
to
address
each
issue.
You
know
as
on
its
own
on
its
face
and
make
determinations
that
way,
so
I'm
not
sure,
what's
what
is
is
either
motivating
them
or
preventing
them
from
from
making
any
kind
of
declaration.
C
A
A
E
A
E
A
E
Through
the
chair,
that's
certainly
something
that
is
worthy
of
consideration.
I,
think
the
issue
at
this
stage
of
the
game
is
when
you
look
at
the
research
and
we
look
at
the
data
in
respect
of
e-cigarettes
and
their
potential
to
provide
a
smoking
cessation
support.
The
data
suggests-
and
it
was
recently
done
by
the
Ontario
tobacco
Research
Unit.
They
have
done
surveys
and-
and
it
indicates
that
the
flavours,
as
reported
by
current
smokers
seeking
to
quit,
do
assist
them
somewhat,
albeit
clearly,
not
in
the
numbers
that
we
were
hoping
to
see.
Okay,.
A
E
Through
the
chair,
it's
it's
not,
there
are
current
tobacco
restrictions
are
for
public
squares.
There
are
certain
park
areas
in
it.
It's
a
combination.
We
have
a
little
bit
through
the
existing
provincial
legislation
and
some
of
which,
which
comes
through
City
of
Toronto
bylaws.
It's
it's
not
all
part
in
it
right
now.
We
don't
have
our
restriction
for
all
parks,
but
yes,
it's
to
line
up.
What
we're
proposing
is
to
line
up
vaping
restrictions
to
existing
restrictions
to
tobacco,
as
currently
legislated
under
City
of
Toronto
bylaws,
okay,.
A
And
so
beyond,
what
we
have
done
thus
far
establishing
a
license.
Now,
that's
required
for
those
who
sell
vaping
products
in
the
City
of
Toronto
recommendation
here
to
develop
a
bylaw,
to
align
the
use
of
e-cigarettes
and
to
have
the
same
policies
as
cigarettes
in
the
city.
Is
there
anything
else
that
the
city
can
do
beyond
those
measures
at.
E
This
stage
of
the
game,
when
I
look
and
when
we
have
looked
at
that
which
can
be
done
from
a
legislative
perspective
regulatory
perspective,
most
of
the
powers
lie
at
the
provincial
and
federal
level.
We
have
certain
purview
over
city,
property
and
city
standards
and
licensing
within
the
context
of
the
city.
But
these
are
the
recommendations
at
this
stage
that
we
feel
are
most
appropriate
and
that
were
within
the
city
purview.
There
are
lots
of
things
that
can
be
done
at
the
provincial
and
federal
level,
hence
the
first
two
recommendations:
okay
and.
A
In
my
final
category
for
questions
revolves
around
taxation.
So
in
the
report
you
go
into
that
british
columbia
has
implemented
a
tax
on
baking
products
similar
to
attacks
on
tobacco,
cigarettes
and
tobacco
products.
Why
haven't
we
seen
a
similar
recommendation
from
you
with
respect
to
the
province
of
ontario
here?
Well,.
E
I
think
at
this
stage
of
the
game,
we
felt
that
the
we
have
evidence
currently
in
respect
of
the
recommendations
made
thus
far.
However,
I
think
it's
certainly
worth
considering,
given
what
we
understand
from
tobacco
legislation
and
our
experience
with
tobacco
in
the
past.
It
would
be
moving
out
into
that
into
an
arena
where
we
don't
have
evidence
but
direct
evidence.
I
should
say,
but
certainly
we
have
some
experience
with
tobacco.
Thank.
C
C
E
Through
you,
madam
chair
I,
admit
I'm,
not
an
expert
in
the
legal
matters,
because
that
would
be
a
legal
question.
My
understanding,
however,
though,
is
that
if
a
product
is,
you
know
legally
made
available
right
and
there's
no
prohibition,
you
know
I'm
not
sure
what
our
purview
would
be.
However,
I
I
do
understand
that
you
know
the
federal
government
has
a
role
to
play
in
this.
It
would
be
interesting
to
ask
our
legal
counsel
if
they
have.
We
have
our
legal
counsel
here
if
we
would
have
any
jurisdiction
over
sale
within
licensed
facilities,
I'm.
G
C
B
C
B
As
director
Donaldson
represents
TDSB
and
I'm,
with
TC
DSP
I'm
wondering
a
school
board.
Representatives
with
over
I'd
say
over
five
hundred
thousand
five
hundred
thousand
students.
How?
What
else
can
we
do
to
expose
the
dangers
of
vaping
to
our
students?
And
it's
not
something
that
you
have
to
answer
now,
but
maybe
to
come
back
to
us
with
a
report
on
what
else
we
can
do
within
our
boards
to
expose
the
dangers
to
our
students.
E
Through
you,
madam
chair
I,
think
there
are
a
couple
of
things
that
can
be
done.
We
talked
a
little
bit
about
the
Youth
Health
Action,
Network
I
do
think
it's
important
to
get,
and
we've
heard
through
that
around
the
table
of
the
importance
of
providing
information
to
support
people
making
good
choices.
I
would
suggest
to
you,
however,
that
education
is
part
of
a
solution,
but,
as
we've
seen
with
most
other
behaviors,
especially
those
that
involve
the
use
of
addictive
substances,
education
will
only
get
you
so
far,
particularly
if
it
comes
from
a
non
pure
source.
C
C
C
J
F
This
is
the
time
where,
very
shortly,
the
Minister
of
Finance
is
doing
public
consultation
about
the
2020
2021
budget.
So
it
is
prudent
for
this
board
through
the
chair
to
speak
before
that
public
consultation
or,
at
the
same
time
writing
to
the
Minister
of
Finance
additional
PSP
esti
taxation,
because
we
saw
in
this
report
what's
happening
right
now.
Mbc
can
be
done
if
it
could
be
done
in
BC.
We
should
be
considering
here
in
this
province,
but,
more
importantly,
the
recommendation
number
for
madam
chair
isn't
going
farther
enough.
F
F
Parents
need
to
have
some
resources
to
address
this
issue
because
their
children
are
using
vaping,
probably
in
front
of
them,
but
definitely
behind
them,
because
we
heard
the
data
right
now
from
MPP
Jonah,
almost
30
percent
of
young
people
in
our
system
are
using
vaping.
So
how
we're
gonna
address
this
so
I
think
we've
got
to
have
more
recommendation
and
passion
about
decision.
So
many
board
members
here
also
very
passionate
about
this
I
think
we
need
more
stuff
on
this
recommendation.
So
thank
you.
A
You
and
I
have
two
amendments
to
place
which
have
been
circulated.
The
first
is
to
urge
the
provincial
government
to
adopt
bill
151
151,
as
we
heard
from
MPP
jelena,
to
strengthen
provincial
measures
to
counteract
the
rise
in
vaping,
and
the
second
is
to
amend
recommendation
3
to
request
that
we
get
a
report
back
in
the
second
quarter
of
2020
on
the
status
of
the
city's
work
to
initiate
a
bylaw.
Let
me
begin,
first
of
all
by
thanking
our
staff,
the
medical
officer
of
Health
and
her
team.
This
board
we've
requested
this
report
in
September.
A
In
fact,
there
are
immediate,
harmful,
short-term
effects
that
we're
seeing
around
the
world
lung
injuries
with
the
nicotine
content,
the
the
impact
on
brain
development
of
adolescents,
and
that
this
is
actually
contributing
to
tobacco
use
and
the
long-term
risks
of
which
we
can
assume.
There
will
be
many
we
aren't
even
aware
of
yet,
and
so,
if
we
do
not
act
now,
we
we
risk
undermining
decades
of
effective
tobacco
control
decades,
and
so,
when
it
comes
to
acting,
thankfully
we're
not
reinventing
the
wheel.
A
A
A
Well,
five
years
later
after
the
harms
have
begun
to
emerge,
we
see
other
levels
of
government
starting
to
act,
and
so,
if
there's
a
lesson
here,
it's
that
all
levels
of
government
need
to
act
yesterday
and
given
that
this
is
an
urgent
issue
that
includes
the
City
of
Toronto
as
well,
and
so
I
want
to
again
thank
our
staff
for
their
hard
work.
This
is
an
issue
that
it's
going
to
come
up
again
and
again
and
again
until
we
act
with
the
urgency
it
requires
and
I'm
happy
to
move
the
recommendations.
Thank
you
and.
C
I
believe
that
everything
that
they've
already
put
forward
in
front
of
us
is
giving
us
some
indication
that
we
need
to
do
more.
We
need
to
do
it
faster.
The
fact
that
we
have
a
number
of
of
school
trustees
who
were
actually
with
us
and
who
have
actually
raised
some
concerns
of
the
activity
that
they're
seeing
on
school
properties,
recognizing
that
the
youth
in
particular
and
the
children
of
Toronto
are
being
targeted
and
the
line
of
defense
between
them
and
their
health
and
their
future.
C
Health
is
really
us
at
the
Board
of
Health,
and
what
can
we
do
in
the
City
of
Toronto
to
eliminate
and
to
reduce
the
harmful
effects
of
this
product,
which
seems
to
we
all
agree
that
we
don't
know
enough?
But
what
we
do
know
right
now
is
a
baseline
is
that
it
is
not
necessarily
a
healthy
product.
We're
asking
them
not
to
pick
up
the
habit,
we're
asking
them
not
to
start
the
consumption,
we're
asking
them
to
basically
not
start
smoking.
C
If
you
do
not
pick
up
the
product
that
you
don't
smoke,
we're
already
seeing
this,
but
at
the
same
time,
availability
of
this
product
seems
to
be
everywhere.
I
worked,
I,
walk
into
a
corner,
store,
jason-2
schools
and
I,
see
more
of
this
product
for
sale
and
advertised
around
these
convenience
stores
and
in
drugstores
than
just
about
any
other
type
of
advertising.
So
it's
extremely
profitable,
but
there
is
going
to
be
a
very
clear
financial
impact
on
the
Canadian
health
system
and
those
and
in
that
of
Toronto
as
well.
C
If
we
don't
actually
address
it
and
I'm
fearful
that,
because
we
started
asking
for
provincial
and
federal
changes,
we
asked
the
provincial
and
federal
government
to
step
in
back
in
2014
when
this
was
first
flagged
about
five
years
ago,
and
they
have
been
very
slow
to
respond.
I
recognize
that
this
particular
motion
may
seem
like
we
are.
C
You
know,
moving
rather
aggressively,
but
when
you
put
into
the
context
of
the
fact
that
five
years
later
we're
still
trying
to
protect
the
children
and
the
youth
of
Toronto
and-
and
we
haven't
made
a
lot
of
progress,
we
are
now
tanker
around
the
edges,
saying
that
we
should
probably
eliminate
advertising.
We
should
probably
eliminate
some
of
the
display
material-
that's
five
years
already
too
late
and
the
population.
That's
now
stepped
forward.
To
start
this
very
addictive
habit.
That
seems
to
lead
to
very
immediate
turds
decline
of
physical,
as
well
as
mental
mental
health.
C
We're
also
going
to
see
much
longer
as
this
as
this
trend
of
consumption
continues
to
to
rise
and,
as
vaping
becomes
more
acceptable
in
social
environments,
as
we
are
seeing
this
across
the
city.
So
that's
what
I'm
doing
I
think
we
need
to
be
able
to
just
understand.
Is
there
more
that
the
City
of
Toronto
can
do
to
protect
its
residents,
especially
the
vulnerable
and
the
young,
and
if
there
is
more
than
let's
get
that
advisement
staff,
and
then
they
can
provide
some
recommendations
on
what
next
subsequent
steps
that
we
can
take?
Are
there
yeah?
A
C
I'm
not
and
I,
don't
think
we
actually
have
the
right
to
as
we
don't
have
the
purview
within
the
Board
of
Health
to
to
implement
a
ban.
This
will
be
something
that
we
would
have
to
do
through
the
city
of
Toronto
and
even
then
I
know
that
there
are
going
to
be
very
clear
regulations
and
recommendations
that
we'll
probably
have
to
go
to
other
standing
committees,
including
municipal
licensing
and
standard
around
licensed
businesses.
It
will
have
to
probably
go
through
the
executive
and
then
a
final
council
decision
and
then
to
implement
a
bylaw.
C
F
C
Chair
we
could
certainly
hold
that
down.
Is
your
motion
ready,
yeah
I've
written
it
in
my
little
piece
of
it?
So
if
you
can
move
that
piece
of
paper
to
the
clerk's
they'll
have
that
typed
up
for
you
I
recognize
that
you
well
I've
also
acknowledged
you
to
introduce
it
as
soon
as
it's
ready.
Okay,
are
there
any
other
questions
for
the
mover?
Okay,
seeing
none?
Are
there
any
other
speakers
or
do
we
need
to
hold
this
matter
down
until
we
get?
This
particular
motion
prepared,
I.
C
C
Okay,
we're
gonna
bring
this
meeting
back
to
order
and
what
I'd
like
to
do
is
number
one
remind
members
of
the
public
under
council
procedures.
You
cannot
disrupt
this
meeting
and
I
asked
you
to
respect
the
committee's
proceedings
and
act
appropriately
and
also
a
reminder
to
members
to
prepare
your
motions
and
amendments
in
advance
and
that
will
probably
help
us
move
the
meetings
along
much
more
efficiently.
So
I
want
to
just
acknowledge
a
director
Wang.
You
have
a
motion
that
you'd
like
to
place
before
the
the
board.
Thank.
F
You
very
much
madam
chair,
so
I
think
it's
it's
been
circulate.
My
motion
has
been
circulated
and
I
think
it's
also
strengthened
what
the
chair
motion
dealing
with
the
whole
issue,
encouraging
the
province
to
do
more,
but
very
clearly.
This
is
a
timeliness
of
my
motion
because,
as
we
speak,
the
province
is
getting
ready
for
their
budget
for
2020.
So
it's
before
you
had
only
to
read
it,
but
the
fact
is
that
we
need
to
ask
for
more
taxation
with
regard
this
is
family
product.
Thank
you.
Okay.
Thank.
C
You
very
much
are
there
any
other
speakers
with
motions
any
other
speakers
without
motions?
No
okay,
so
we're
ready
to
vote
if
we
can
probably
take
the
the
motions
as
as
it
original
package,
is
that
Alright
yeah?
Okay,
all
those
in
favor
and
recorded
all
those
in
favor.
This
is
a
request
for
a
recorded
vote.
C
Yes,
okay,
okay,
that's
it
okay!
So
the
item
has
been
adopted
as
amended.
Thank
you
very
much.
We
will
now
move
to
our
next
item
and
thank
you
very
much
members
for
that
very
good
discussion.
Hl
12.4,
Toronto
Public
Health
organizational
review.
We
do
have
members
of
the
public
who
are
registered
to
speak
on
this
particular
matter.
The
first
person
I'd
like
to
call
Aisha.
Oh,
we
have
a
presentation.
Oh
sorry,
my
apologies.
Anyone
take
away
your
time.
Okay,
so
we
have
a
presentation
from
a
medical
officer
of
Health
and
please
begin
when
you're
ready.
E
Thank
you,
madam
chair,
and
thank
you
for
all
of
you
for
your
attention
this
morning,
I
will
be
presenting
to
you
on
the
screen,
a
presentation
regarding
our
report
on
Toronto
Public
Health's
organizational
review.
You
may
recall
that
this
item
was
actually
raised
and
brought
up
at
the
October
Board
of
Health,
and
there
was
a
particular
request
for
an
update
to
be
provided
in
respect
of
the
status
of
the
review
and
that's
what
we're
going
to
be
doing
today.
E
So,
as
you
can
see
here,
we're
back
to
back
on
slide
2,
while
just
to
give
you
a
little
bit
of
context.
Toronto
Public
Health
has
undergone
a
number
of
changes,
much
growth
and
evolving
priorities,
not
surprisingly,
as
our
city
has
changed
and
grown
over
the
many
years.
However,
as
it
turns
out,
Toronto
Public
Health
as
an
organization
in
totality
as
a
whole
has
not
actually
been
reviewed.
E
Since
the
organization
itself
was
created
in
1998
the
whole
organization
right,
there
have
been
smaller
reviews
and
specific
sub
segments
that
have
been
reviewed,
but
not
the
entire
organization
since
back
in
1998.
So
as
it
turns
out,
it's
within
that
context
that
in
2017
as
part
of
the
budget
process,
City
Council
directed
the
then
medical
officer
of
Health
or
the
incoming
medical
officer
of
health
I
think
both
of
us
were
directed
at
that
time,
as
I
was
just
coming
in
to
conduct
an
organizational
review.
E
However,
in
between
that
2017
budget
and
the
you
know,
as
we
moved
into
2018,
there
were
a
number
of
emerging
issues
that
were
identified
and
felt
to
be
of
validity
and
importance
in
terms
of
inclusion
in
the
organizational
review,
and
these
included
things
like
budget
pressures
that
relate
to
population
growth
and
an
increasingly
dense
City.
The
new
2018
Ontario
public
health
standards,
which
require
an
increased
focus
on
the
use
of
evidence
and,
in
particular
on
policy
interventions.
E
To
address
population
health,
there
were
also
other
emerging
issues
that
this
board
will
be
very
familiar
with
in
respect
of
what's
pressing
on
the
city,
things
like
housing,
affordability,
mobility
and
other
challenges
that
face
our
growing
city
so
taken
all
together.
When
you
looked
at
the
council
direction
and
the
emerging
issues
that
were
coming
up
as
we
were
moving
forward
as
an
organization,
we
put
these
together
to
determine
some
specific
outcomes
that
the
organization
review
would
actually
achieve
or
address
in
its
process,
and
those
are
articulated
here
on
this
slide.
E
E
So
turning
now
to
the
specific
findings
of
the
review.
First,
let's
look
at
the
current
state
assessment
and
the
current
state
assessment
at
Toronto.
Public
Health
identified
a
number
of
needs
and
opportunities
for
improvement,
and
these
are
explained
to
you
on
this
slide,
but
just
to
give
you
a
little
further
detail.
One
of
the
opportunities
that
was
identified
through
the
review
was
the
opportunity
to
put
similar
functions
together
to
create
strategic
and
program
integration
and
accountability
rather
than
having
different
units
or
directorates
and
teams
within
the
context
of
the
organization
functioning
in
a
siloed
manner.
E
Other
opportunities
and
again
I'm,
going
through
the
slide
here
with
you.
The
need
to
create
a
foundational
support
function
so
as
to
coordinate
services
across
Toronto
Public
Health
and
to
liaison
a
more
consistent
and
coordinated
fashion
with
the
city's
corporate
service,
rather
than
having
each
Directorate
in
each
section
within
Toronto,
Public
Health
approaching
our
city
partners
on
human
resources
issues
or
information
technology
issues.
E
And
finally,
there
was
identified
a
need
to
increase
the
use
of
evidence
and
data
in
program
and
and
intervention
development
to
ensure
that
we're
able
to
achieve
that
we're
best
positioned
to
achieve
health
outcomes
that
we
seek
to
achieve
in
the
most
effective
and
efficient
use
of
our
resources,
and
then
things
you
know
we
were
progressing
I,
think
reasonably
well
and
then
came
April
2019,
which
changed
a
number
of
circumstances
and
the
folks
around
this
table
are
quite
familiar
with
that.
The
organizational
review
work
was
in
fact
paused
for
us
in
April
2019.
E
E
First,
before
anything
changes,
so
let's
now
turn
to
the
next
slide
and
to
give
you
a
high-level
summary
of
the
main
recommendation
or
one
of
the
main
recommendations
of
the
review
and
it
that
was
regarding
the
introduction
of
a
new
organizational
structure
that
groups
our
functions
into
these
four
key
areas
to
solidify
what
we
can
do
in
each
of
these
areas.
So
there
health
protection,
health
promotion,
effective
public
health
practice
and
public
health
foundations
at
a
very
high
level
health
protection
is
focused.
E
Is
that
area
which
is
focused
on
public
health
mandate
of
preventing
and
reducing
the
ill
impact
of
infectious
and
communicable
diseases
and
relates
to
reducing
or
eliminating
exposures
to
hazards
in
our
environment
and
talks
about
the
kinds
of
activities
that
will
include?
Prevention
will
include
treatment,
inspections,
enforcement
and
containment.
That's
all
within
the
health
protection
function.
E
Our
understanding
on
the
interventions,
the
best
available
interventions,
including
enabling
technology,
so
that
we
can
continue
to
develop
and
deliver
leading-edge
health
promotion
and
protection
interventions
so
as
to
advance
health
outcomes
and,
finally,
public
health
foundations,
which
supports
the
effective
planning
and
operation
of
Toronto
Public
Health
through
such
activities
as
strategic
planning,
community
and
stakeholder
relations,
project
management
and
our
liaison
with
key
corporate
service
functions.
So
that's
the
basic
structure,
the
core
functions
and
the
way
in
which
the
review
suggested.
We
would
best
organize
ourselves
to
meet
the
needs
of
a
changing
population.
E
Moving
to
the
next
slide
effectively.
What
happened
was
that
as
we
had
this,
you
know,
functional
structure.
Moving
towards
this
functional
structure
actually
provides
the
framework
for
us
to
start
to
implement
proactive
changes,
and
this
is
important,
particularly
in
the
context
of
that
which
is
happening
with
the
province
and
their
so
called
modernization
efforts
for
Public
Health.
That
is
their
term.
E
So
the
kinds
of
things
that
we
have
been
able
to
do
as
a
result
of
this
functional
structure
and
given
what
we
know
from
the
provinces,
modernization
efforts,
we've
been
able
to
try
and
adjust
service
delivery
to
increase
organizational
efficiency
and
effectiveness.
We
have
used
the
structure
to
help
us
address
span
of
control,
as
directed
by
council
back
in
2017,
particularly
in
those
areas
where
the
number
of
direct
reports
was
relatively
small.
E
We've
used
this
opportunity
to
better
coordinate
the
work
of
teams
which
have
similar
goals
or
functions,
to
develop
and
create
program
synergies
and,
in
some
cases,
to
improve
the
client
interface,
where
we've
had
programming
that
sometimes
interacts
with
external
clients,
but
it
sits
across
several
different
areas
of
public
health.
We
understood
from
our
clients
that
that
was
not
the
most
satisfactory
interaction
for
them
to
have
to
go
to
five
different
places
within
or
however
many
different
places
within
Toronto
Public
Health,
not
to
address
their
various
needs.
E
Bringing
these
programs
together
and
aligning
them
better
gives
us
an
opportunity
to
better
meet
client
needs
in
a
more
user-friendly
way.
And
finally,
we
have
also
taken
the
opportunity
to
embed
policy
functions
within
program
areas
to
more
effectively
meet
policy
requirements,
as
stipulated
in
the
2018
Ontario
public
health
standards,
so
I'm
now
taking
us
through
two
slides,
10
and
11.
E
Yeah
we'll
have
to
try
to
figure
out
whether
we
can
expect
it
is
a
little
bit
of
a
vision
test
and
for
that
I
apologize
we'll
have
to
get
you
stronger
magnifiers.
However,
again
this
is
just
a
high
level
picture.
We
can
see
what
we
can
do
about
blowing
them
out.
I
admit:
I
am
even
with
my
progressive
lenses.
E
I
had
some
challenge
in
reading
the
the
fine
font,
but
suffice
it
to
say
that
on
the
first
slide
that
slide
10,
what
you
have
is
the
Toronto
Public
Health
organizational
chart
for
2018
and
on
slide,
11
and
I
do
hope.
I
have
my
numbers
correct.
The
second
is
our
that
that
slide
11
is
our
current
organizational
chart.
I
can
tell
you
that
in
general,
adjustments
have
been
made
to
reflect
the
four
functional
areas,
as
recommended
and
articulated
in
our
organization
review.
That
I
spoke
to
earlier.
E
E
So
those
are
our
two
organizational
charts.
Moving
on
to
slide
12.
Our
plan
is
to
continue
to
implement
the
recommendations
from
the
organizational
review
so
that
we
can
continue
to
demonstrate
leadership
in
the
broader
field
of
Public
Health
and
to
serve
the
residents
of
Toronto
as
best
as
possible,
regardless
of
what
our
funding
circumstance
looks
like.
We
recognize
that
we
don't
have
full
control
over
that
which
happens
within
the
broader
public
health
sector,
whether
it's
from
a
governance,
a
mandate
or
a
funding
perspective.
E
However,
we
are
patently
clear
about
our
objectives
and
our
desire
to
improve
the
health
status
of
the
population,
to
reduce
disparities
in
health
status
and
to
ensure
that
were
prepared
for
an
able
to
respond
effectively
to
outbreaks
and
emergencies.
We
are
also
patently
clear
as
an
organization
that
we
must
focused,
first
and
foremost
on
prevention,
and
do
we
must
do
so
in
a
population
health
way.
If
we
do
not
do
those
activities,
there
are
no
other
partners
in
this
who
are
positioned
poised
or
skilled
to
discharge
those
obligations
on
to
the
next
slide.
E
I
think
the
interesting
thing
about
this
objectives
are:
these
objectives
is:
if
we're
able
to
actually
succeed
on
those
objectives,
we
by
definition
enhance
the
sustainability
of
healthcare.
So
with
that
I'm
going
to
take
us
to
our
last
slide
and
give
you
some
concluding
remarks,
Oh
was
that
my
last
slide,
okay,
I
thought
I
had
one
more.
So
let
me
just
bring
you
to
concluding
remarks.
This
is
an
important
time
in
public
health.
Our
province
is,
is
actively
reviewing
and
undertaking
what
they've
described
as
a
modernized
or
modernization
initiative.
E
We
know
of
funding
changes.
That's,
at
least
for
the
short-term,
is
fairly
clear
where
they're
going
on
that
the
long
term
remains
a
little
bit
uncertain.
We
know
that
the
province
has
embarked
on
a
consultation
process
in
respect
of
the
public
health
sector,
and
we
know
that
we
are
serving
a
growing
city
that
has
a
number
of
complex
challenges
that
we
need
to
address
and
that
have
significant
impact
on
health
status
and
on
inequities
and
disparities
in
health.
I
do
look
for
it
and
I
know.
E
I
can
speak
for
the
entire
organization
when
I
say
that
we
look
forward
to
ongoing
support
from
the
Board
of
Health
and
your
important
role
in
governance
of
of
public
health,
as
it's
conducted
here
in
the
city.
I
know
that
we
can
count
on
you
on
your
support,
as
we
move
forward
with
our
organization
enhancement
efforts
in
our
organization
review
efforts
all
aimed
at
improving
health
status,
reducing
disparities
and
ensuring
that
we're
able
to
respond
effectively
to
outbreaks
and
emergencies.
E
I
know
that
this
table
does
not
need
to
hear
more
about
the
importance
of
the
social
determinants
of
health
and
how
key
it
is
for
us
to
move
forward
in
ensuring
that
we
address
the
social
determinants
of
health,
with
the
prevention
lens
and
with
the
population
health
lens.
It's
interesting
having
been
too
many
tables
around
the
public
health
modernization
efforts.
C
C
Thank
you
for
for
that
correction?
Our
next
speaker
is
Bryan
Noble
and
if
I
can
actually
invite
members
of
the
public
who
are
interested
in
speaking
to
item
number
for
please
let
the
the
clerk's
know,
and
they
can
update
the
speaker's
list
and
will
you
will
you
be
speaking
together
to
share
five
minutes
or
five
minutes
for
the
one?
Okay,
when
you're
ready?
Please
proceed.
K
And
members
of
the
Board
of
Health
for
the
opportunity
to
depute
to
you
today
with
all
the
political
changes
taking
place
around
us,
we
want
to
reinforce
the
importance
of
sexual
health
services
to
the
ongoing
health
of
the
people
of
Toronto.
The
clinics
that
we
represent,
I
WH
see
Toronto
a
hassle
free
clinic
and
the
birth
control
and
sexual
health
center
have
worked
along
with
pioneers
like
dr.
Marion
Powell
sue
Johansson,
dr.
Sheila
Besser,
to
ensure
the
provincial
government
mandated
services
and
committed
funding
to
adequately
address
the
sexual
health
needs
of
our
city.
K
The
network
of
sexual
health
clinics
that
has
been
established
over
the
years
by
Toronto
Public
Health
is
one
of
the
most
effective,
efficient,
innovative
and
well
used
in
the
entire
country.
It
targets
high-risk
populations
such
as
men
who
have
sex
with
men,
those
without
health
cards
and
those
without
access
to
a
family.
K
They
use
these
services
because
there
is
no
health
care
requirement,
just
a
welcoming
environment
without
stigma,
so
do
other
members
of
vulnerable,
undeserved,
underserved,
sorry,
communities
who
may
have
cards
but
limited
access
to
family
physicians
and
nowhere
else
to
go.
The
sexual
health
clinics
provide
low-cost
birth
control
and
free
medications
to
treat
sexually
transmitted
infections.
The
Wellesley
Institute
recently
reported
that
one
in
five
working
Ontarians
have
no
drug
coverage
for
racialized
communities
or
recent
immigrants
in
part
in
part-time
employment
and
excluded
from
coverage.
These
services
are
a
lifeline.
K
The
very
reasons
that
necessitated
the
establishment
of
the
sexual
health
program
decades
ago
still
exist
and
Toronto
Public
Health
continues
to
acknowledge
these
imperatives
through
this
excellent
network
of
sexual
health
clinics.
I
know
that
you
are
familiar
with
the
clinics
and
the
statistics,
but
I'd
like
to
reiterate
what
we're
facing
the
combined
incidence
rate
for
all
reportable
sexually
transmitted
infections
in
Toronto,
increased
by
58
percent
from
2008
to
2018.
This
mirrors
trends
in
other
Canadian
and
international
jurisdictions
of
a
local
and
global
decline
and
safe
sex
practices.
K
Sexually
transmitted
infections
made
up
63
percent
of
commonly
reported
infectious
diseases
in
Toronto
in
2017.
The
high
and
increasing
numbers
of
STI
s
underscore
the
importance
and
the
need
for
sexual
health,
education,
counseling
and
clinical
services.
The
asymptomatic
nature
of
STI
s
means
many
cases
go
unreported
and
that
the
true
number
of
STI
s
may
not
be
known
among
young
women.
Early
stages
of
gonorrhea
and
chlamydia
are
often
asymptomatic
and
therefore
go
untreated.
K
Approximately
40,
40
%
of
such
cases
can
progress
to
pelvic
inflammatory
disease,
leading
to
chronic
pain,
damage
to
fallopian
tubes,
an
increased
risk
of
ectopic
pregnancy
and
possible
infertility,
STI
prevention
is
clearly
desirable,
and
early
detection
through
clinical
services
is
very
important
to
spread
to
prevent
the
spread
of
STI
s
and
HIV
and
lead
to
earlier
treatment.
Knowledge
of
HIV
status
is
recommended
for
all
sexually
active
people
through
testing
individuals
at
high
risk
should
be
tested
more
often,
despite
advances
in
testing
and
treatment,
HIV
still
presents
a
large
health
concern.
K
Approximately
50%
of
HIV
positive
cases
in
Ontario
are
from
Toronto
those
that
are
not
diagnosed
and
treated
early
have
an
approximately
50%
reduction
in
life
expectancy.
In
2017,
there
were
500
newly
diagnosed
HIV
cases,
83%
of
which
were
male
and
79%
of
those
were
men
having
sex
with
men
in
terms
of
women
and
contraception.
K
Self-Perceived
ability
to
make
informed
choices
is
a
key
component
of
positive
sexual
health
access
to
services
for
low-income
women,
those
without
health
cards
and
those
without
a
primary
health
care
physician
where
they
can
purchase
low-cost
contraception
in
a
safe
and
non-judgmental
environment
is
still
crucial.
Providing
free
condoms
is
also
very
important.
K
Consistent
condom
use
is
a
sexual
health
tool
for
protection
against
sti's
and
preventing
unplanned
pregnancies
and
yet
fifty-five
percent
of
sexually
active
adults
in
our
city
reported
using
no
method
of
protection
see
abortion
access
for
those
without
health
cards
can
be
close
to
impossible
unless
they
can
be
directed
to
the
one
site
in
the
city.
That
does
not
require
a
health
card
or
payment
for
procedure.
Unplanned
pregnancy
prevention
is
critical
for
these
vulnerable
women,
whose
choices
are
so
limited.
We
believe
the
situation
speaks
for
itself.
K
The
sexual
health
program
that
has
been
providing
these
necessary
services
must
be
maintained
and
strengthened,
responding
to
the
needs
that
are
still
present
and
growing.
There
is
no
one
else
to
take
this
on.
We
congratulate
Toronto
Public
Health
for
the
work
it
has
been
doing
this
critical
area.
Our
boards
and
volunteers
have
also
been
working
hard
in
our
communities
over
the
last
year
to
preserve
Public
Health.
K
We
also
want
to
acknowledge
the
inspiring
role
of
acting
chair,
Kristyn
wong-tam,
acting
Vice
Chair
Joe
Cressy,
all
the
members
of
the
Board
of
Health,
the
medical
officer
of
Health,
Eileen
Davila
and
Mayor
John
Tory
in
the
fight
to
keep
public
health
an
integral
part
of
the
Ontario
health
care
system.
Thank
you
so
much
thank.
K
Formerly
known
as
the
immigrant
woman's
health
center,
and
we
chose
to
change
our
name
a
couple
of
years
ago,
as
we
started
to
see
men
at
our
clinic
as
we
know
that
the
need
for
sexual
health
testing
for
men
is
as
critical
as
it
is
for
women,
and
especially,
we
offer
language
where
you
serve
in
seven
different
languages.
So
that
is
something
that
allows
people
that
don't
have
the
language
skills
to
be
able
to
come
to
our
clinic
and
get
counseling
and
testing.
And.
A
K
A
K
Is
correct:
we
serve
a
large
number
of
vulnerable
communities
and
peoples
through
our
clinic
work.
We
offer
a
lot
of
access
in
terms
of
extra
hours
that
are
not
available
through
some
of
the
public
health
clinics,
and
so
we
feel
very
strongly
and
people
in
our
community
as
well
access
these
services
quite
regularly,
which
is
showing,
through
the
higher
numbers
of
of
testing
and
positive
sti's,
that
we
see
through
our
clinic
work.
K
C
It's
all
my
questions.
Ok,
thank
you
very
much.
Any
other
members
to
question
I
have
a
couple
quick
questions.
With
respect
to
the
report
we
just
received
from
the
medical
officer
of
Health
there.
There
wasn't
a
lot
of
detail
in
terms
of
there
was
a
big
chart.
I
think
we
saw
it
was
very
difficult
to
read,
but
I
don't
think
we
got
into
the
details
of
the
the
big
overall
changes
like
there
is
definitely
going
to
be
some
shifts.
C
K
I
can
tell
you
from
our
experience
we
were
at
this
table.
I
was
at
this
table
five
years
ago,
I
think
five
years
ago
now,
when
budget
cuts
were
introduced
into
Toronto
Public
Health
through
by
mayor
Ford
and
immigrant
woman's
health
center
was
one
of
the
one
of
the
first
sexual
health
clinics
on
the
table.
So
it
is
always
a
risk.
K
It
has
been
a
risk
throughout
the
history
of
sexual
health
clinics,
especially
the
independently
funded
ones,
so
whether
there
is
a
an
explicit
or
implicit
risk,
we
know
that
it's
there,
and
so
we
felt
it
was
very
important
for
us
to
come
and
and
show
the
importance
of
these
services
to
the
people
of
the
City
of
Toronto.
Okay,.
I
L
Thank
you,
madam
chair
good
morning,
members
of
the
Board
of
Health
I
want
to
thank
you
for
giving
me
the
opportunity
to
come
and
speak
to
you
here
today.
As
we
said,
my
name
is
Ryan
noble
I'm,
the
executive
director
of
the
North
York
Harvest
Food,
Bank
I'm,
also
a
member
of
the
Toronto
Food
Policy
Council,
and
on
the
board
of
directors
of
feed
Ontario,
which
was
formerly
the
Ontario
Association
of
foodbanks.
L
L
I
will
say
that
we,
as
an
organization,
have
been
more
vocal
on
Toronto
Public
Health
this
year
than
we
ever
expect
it
to
be.
We
do
not
receive
any
funding
from
Toronto
Public
Health.
In
fact,
all
of
our
core
operations
of
distributing
food
are
funded
through
private
donations
or
through
private
fees
that
we
collect.
So
we
not
not
to
say
it
in
the
wrong
term,
but
we
have
no
vested
interest
ultimately
in
the
budget,
composition
or
funding
of
public
health
as
an
organization.
L
What
we
do
have
an
interest
in
is:
we
have
seen
firsthand
the
impact
that
Toronto
Public,
Health
and
specifically
Toronto
food
strategy
within
public
health
has
had
in
partnership
with
organizations
like
ours,
for
the
clients
that
we
serve
and
within
the
communities
in
which
we
operate.
So
I
am
here
today
to
the
best
of
my
ability
to
speak
on
behalf
of
those
clients
in
those
communities.
To
that
end,
we
are
I
want
to
express
gratitude.
L
We
were
here
going
back
into
the
spring
when
we
collected
hundreds,
if
not
thousands,
of
signatures
protesting,
the
provincial
governments
cuts
to
Toronto
Public
Health.
It
was
my
privilege
to
present
that
to
councillor
cressie
MPP
Faisal
Hassan,
who
is
a
North
York
harvest,
local
MP
MPP,
so
that
those
could
be
formally
introduced
into
the
provincial
legislature.
We
were
also
here
last
month,
speaking
to
the
importance
of
having
dedicated
strong
staff
support
for
the
Toronto
Food
Policy
Council,
and
with
that
I
want
to
express
my
gratitude
for
seeing
that
position.
Elevated
at
a
management
level.
L
I
think
that's
critical
to
the
type
of
work
that
we
need
to
do,
but
I
am
also
concerned
and
I
need.
I
would
like
to
share
just
some
quick
observations
with
you
that
in
the
new
structure,
we
will
see
food
as
a
concept
food
as
a
strategy
diminished
and
narrowed
in
its
focus
to
some
to
issues
around
disease
prevention
and
nutrition,
and
certainly
food
has
a
significant
role
when
we're
talking
about
things
like
diabetes
or
heart,
disease
or
cancer.
L
Who
is
participating,
who
is
not
participating,
also
the
public
policy
regime
and
how
it
supports
people,
particularly
our
most
marginalized
communities,
in
meeting
their
basic
needs.
You
cannot
look
at
a
neighborhood
through
that
food
lens
and
not
come
across
issues
of
climate
change
and
community
resilience
in
the
face
of
climate
emergencies.
L
Other
types
of
types
of
initiatives
around
those
key
important
things.
So
for
us,
what
we
see
and
what
I
would
like
to
share
with
you
is
the
work
of
Toronto
food
strategy
at
a
very
strategic
level,
creates
a
multiplier
effect
and
through
very,
very
soft
interventions
with
organizations
like
ours
have
a
ripple
effect
throughout
our
community
on
some
very,
very
key
files
and
I
encourage
in
whatever
structure
that
Toronto
Public
Health
emerges
within
that
that
key
role
as
a
strategic
lens
by
which
we
examine
our
communities
is
protected
and
maintained.
Thank
you
very
much.
Are.
C
No
questions,
okay,
thank
you
very
much,
Ryan
acute,
so
I
don't
believe
it.
There
are
any
other
members
of
the
public
here
to
speak
to
this
item.
We
can
bring
the
the
conversation
back
internally.
Are
there
any
questions
of
staff
of
they're,
very
detailed
presentation,
very
big
presentation,
anyways.
A
Thank
you
and
I
have
an
amendment
if
it
can
be
placed
of
his
advanced
circulated.
The
reason
I
didn't
have
questions
in
case
people
are
wondering
is
because
this
is
a
really
really
big
item.
This
was
initiated
and
reported
on
around
the
time
that
we
had
an
election
and
a
transfer
of
the
Board
of
Health
in
terms
of
turnover
new
members.
It
was
an
item
that
was
lost,
as
the
report
noted
in
part
because
of
provincial
announcements
this
past
spring,
and
it
is
also
uncertain
in
light
of
provincial
restructuring.
A
But
then
we
can't
take
away
from
the
fact
that
there
was
work
that
was
done
internally
previously
on
this
I
think
it
needs
a
deep
dive,
I
think
from
a
board
level.
As
the
chair
of
this
board,
I
want
to
be
part
of
doing
that
deep
dive
into
what
is
the
organizational
review
going
forward,
especially
in
light
of
provincial
changes
and
rather
than
have
an
item.
That's
at
the
end
of
a
committee
meet
at
a
board
meeting
when
we're
all
rushed.
There's
always
lots
on
the
agenda.
A
I
would
like
to
have
a
focused
subcommittee,
just
as
we
do
with
budget
to
delve
into
this
to
come
back
to
the
board,
with
recommendations
so
that
we
move
forward
appropriately
in
calling
conversations
with
members
around
the
table.
I've
heard
from
director
perks
and
Mulligan,
who
have
both
expressed
interest,
I've
recommended
that
the
three
of
us
take
on
that
work
on
our
behalf.
A
A
Number
three
and
the
motion
is
that
the
meetings
will
be
called
at
the
will
of
the
chair
and
I
put
myself
down
to
chair
the
subcommittee,
so
I
will
endeavor
to
make
sure
that
we're
coming
back
in
2020
I
would
say,
probably
in
the
second
quarter
as
fast
as
we
can
I
would
imagine
probably
early
in
the
second
quarter.
Thank.
C
You
and
with
respect
to
the
the
deep
dive
and
I
do
I
do
appreciate
the
fact
that
yourself
and
director,
Mulligan
and
perks
is
gonna.
Do
the
heavy
lifting
for
us
I
think
we're
all
very
grateful
that
you'll
do
that,
but
the
deep
dive
and
some
of
the
concerns
that
were
already
raised
by
the
deputies,
because
once
this
once
the
the
report
leaves
us
and
the
work
is
going
into
this
this
new,
this
new,
almost
subcommittee.
C
If
there
is
any
major
Flags
anything
that
we
should
be
aware
of,
I
recognize
that
you'll
be
calling
the
meeting
but
reporting
back
in
2020.
Is
there
anything
that
we
need
to
know
if,
if
there's
something
that
needs
to
jump
back
to
this
board
into
a
larger
public
venue
more
public
facing
earlier
than
that,
so.
A
What
I
would
say
is
the
medical
officer
of
Health
noted
at
any
time.
There
are
any
changes,
this
board
will
be
a
prize,
and
so,
as
a
subcommittee,
we
will
tell
then-
and
so,
if
there
are
changes
that
if
there
are
items
to
discuss
sooner
than
a
full
and
comprehensive
report,
we'll
bring
it
back.
Okay,.
C
D
This
is
it
may
not
look
like
it,
but
this
is
actually
the
most
important
thing
we
will
do
during
this
term
of
office
on
the
Board
of
Health
I've
been
in
and
around
Toronto
Public
Health
for
a
lot
of
my
working
life,
sometimes
as
a
community
activist
working
on
environmental
determinants
of
health,
sometimes
as
a
member
of
City,
Council
and
well,
it's
true.
We
haven't
completely
reformed
the
structure
of
Toronto
Public
Health.
D
Doing
the
work
to
look
at
some
of
the
stuff
we
heard
about
in
terms
of
how
complex
food
issues
really
are,
and
sexual
health
issues
really
are
and
how
all
of
these
things
layer,
together
and
through
that
we
were
able
to
design
both
some
of
the
organizational
structures
and
some
of
the
policy
work
in
real
partnership
with
the
best
learnings
from
a
lot
of
different
people
in
the
health
sector.
And
then
we
need
to
remember
that
our
current
premier
once
sat
on
Toronto
City
Council
and
was
deeply
critical
of
that
kind
of
work.
D
C
C
C
A
I
actually
I
have
an
amendment
to
it.
You'll,
forgive
me
so
and
just
to
speak
to
the
amendment
can
be
placed,
which
is
to
request
the
Ministry
of
Health
and
the
special
advisor
to
the
Minister
of
Health
on
Public
Health,
modernization
to
consult
directly
with
our
board
in
tph
on
their
changes.
I've
requested
a
formal
meeting
and
have
not
yet
heard
back
and
I
know.
Dr.
A
Davila
has
also
requested
a
meeting
which
is
not
taking
place
yet
so
that's
to
formally
request
that
this
is
the
Ministry
of
Health
released
a
discussion
paper
and
they
are
soliciting
feedback
from
the
public
and
organization
and
stakeholders
on
that
discussion,
paper
by
February,
the
10th
and
so
I.
The
motion
in
front
of
us
today
in
the
letter
is
to
request
dr.
A
Davila
to
report
to
our
January
13th
meeting
on
the
status
of
consultations,
any
feedback
and
advice
that
she
has
for
us
with
respect
to
the
modernization
paper
such
that
we
as
a
board
might
consider
whether
we
take
a
position
on
it,
but
also
whether
as
a
board,
we
want
to
be
encouraging
others
to
provide
feedback
through
the
survey,
so
we'll
be
having
that
conversation
in
January
and
that's
the
reason
in
the
rationale
for
the
recs
and
my
letter.
Thank
you.
Okay,.
C
Thank
you
very
much.
Anyone
to
anyone
needing
to
ask
questions
to
clarify
the
motion.
The
amendment
okay,
seeing
none
we're
ready
to
vote
all
those
in
favor
any
opposed
that
carries.
Thank
you
very
much,
okay
and
motion
to
adopt,
as
amended
all
those
in
favor
any
opposed
that
carries.
Thank
you
and
our
last
item
is
a
letter
from
counselor
of
director
perks.
The
title
is
anti
black
racism
training
director
did
you
need
to
speak
to
this
particular
matter?
I.
D
B
C
B
D
D
C
Don't
think
there's
a
vote
before
us,
but
your
recommendation
and
suggestion
is
noted.
Yeah,
okay,
anyone
else
with
questions
for
the
mover.
Okay,
see
none
anyone
else
to
speak,
okay,
seeing
none
all
those
in
favor
any
opposed
that
carries.
Thank
you
very
much,
so
we
don't
have
any
other
items.
We've
cleared
everything
on
our
agenda.
I
want
to
thank
all
the
the
directors
and
staff
for
today's
very
effective
and
efficient
meeting.
Thank
you.