►
From YouTube: Board of Health - January 13, 2020
Description
Board of Health, meeting 13, January 13, 2020
Agenda and background materials:
http://app.toronto.ca/tmmis/decisionBodyProfile.do?function=doPrepare&meetingId=17049
Meeting Navigation:
0:09:35 - Call to order
Agenda Items:
0:10:29 - HL13.1 - Election of Chair for 2020 - Board of Health (Ward All)
0:14:05 - HL13.2 - Election of Vice Chair for 2020 - Board of Health (Ward All)
0:15:13 - HL13.3 - Promoting and Ensuring Accountability at Toronto Public Health (Ward All)
0:12:13 - HL13.4 - 2019: A-Year-in-Review of Toronto Public Health (Ward All)
0:25:45 - HL13.5 - Housing Approaches that Support Health (Ward All)
0:44:29 - HL13.6 - Ministry of Health's Consultation on Changes to Public Health in Ontario (Ward All)
1:44:23 - HL13.7 - Mobile Dental Clinic Program - Three-Month Pilot of Alternate Service Delivery Model (Ward All)
1:55:45 - HL13.8 - Subway Health Impacts Study (Ward All)
0:13:05 - HL13.9 - Assessing the Impact of Expanded Gambling in Toronto (Ward All)
A
A
A
A
So
we
have
quorum
and
I
will
call
this
first
meeting
of
the
Board
of
Health
for
2020
to
order
so
welcome
to
members
of
the
board
to
the
other
members
of
council
in
attendance
today
and
to
members
of
the
public.
You
can
follow
the
agenda
and
debate
on
your
computer
tablet
or
smartphone
at
wwr
OCA,
slash,
council.
A
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
Hooda
nashoni
and
the
when
dot
peoples
and
is
now
home
to
many
diverse
First,
Nations,
Inuit
and
maytee
people's.
We
also
acknowledge
that
Toronto
is
covered
by
treaty.
Thirteen
with
the
Mississauga's
of
the
credit
are
there
any
declarations
of
interest
under
the
meanest
fell,
conflict
of
interest
act
being
none.
The
first
item
of
business
is
election
of
chair
for
2020
Board
of
Health.
A
A
So
director
wrong,
tam
has
nominated
director
Cressy
director
crécy.
Do
you
accept
the
nomination,
so
I'm
calling
nominations
a
second
time?
Are
there
any
further
nominations?
I'm
calling
nominations
a
third
and
final
time.
Are
there
any
further
nominations,
as
there
are
no
further
nominations?
The
nominations
are
now
closed.
Director
Cressy
is
the
only
nominee
so
I
declare
director
crécy
elected
as
chair
of
the
Board
of
Health
for
a
term
of
office
starting
January,
13
2020
and
ending
January
December,
31st
2020
and
until
a
successor
is
appointed.
A
C
Well,
thank
you
kindly
and
thank
you
to
director
Wang
Tam,
for
that.
We
will
now
proceed
with
a
run-through
of
the
agenda.
We're
gonna
go
through
the
whole
orange
sheets
before
dealing
with
each
item
so
on
the
orange
sheets,
as
we
go
through
item
13.2
election
of
a
vice
chair
for
2020
Board
of
Health
that
will
be
held
down
as
we
have
to
deal
with
it
item,
HL,
13.3,
promoting
and
ensuring
accountability
at
Toronto
Public
Health.
C
We
have
speakers
on
that,
so
that
will
be
held
item
H
L
13.4
2019
a
year
in
review
of
Toronto
Public
Health.
Would
anybody
like
to
hold
that
down?
Okay,
seeing
none
move?
Dr.
Leighton
is
moving
to
receive
the
report,
all
those
in
favor
opposed
if
any
that
carries
item
HL,
13.5
housing
approaches
that
support
health.
There
is
speakers
so
that
will
be
held
down
item
HL
13.6
ministry
of
health.
C
Consultation
on
changes
to
public
health
in
Ontario
I
would
like
to
hope,
there's
a
presentation
so
that
will
be
held
down
item
H,
L
13.7
mobile
dental
clinic
three
month
pilot
on
alternate
service
delivery
model.
I
would
like
to
hold
down
item
HL,
13.8
subway
health
impact
study.
There
are
speakers
and
I
believe
there
is
one
new
business
item
that
needs
to
be
added
to
the
agenda.
It
comes
from
director
Layton
concerning
gambling.
C
A
C
There
any
desire
to
hold
that
down
for
questions
or
comments,
or
is
our
people
comfortable,
moving?
Okay,
so
well
moving
the
recommendations
in
the
letter
from
director
Layton
all
those
in
favor
opposed
if
any
that
carries.
Okay
will
now
proceed
back
to
the
formal
agenda
item
HL
thirteen
point
two
election
of
a
vice
chair
for
2020
Board
of
Health.
C
C
C
Congratulations,
okay,
so
carrying
right
along
item
will
move
into
item
HL,
13.3,
promoting
and
ensuring
accountability,
Toronto
Public
Health.
There
are
two
speakers.
Our
first
speaker
is
Derek
Warren
Derek.
You
know
the
drill.
There
is
a
clock
on
my
right.
You'll
have
five
minutes
and
you
can
begin
when
you're
ready.
D
C
D
Want
to
point
out
that
clapping
is
allowed
here
after
all,
I
just
want
to
say
by
me
speaking
at
this
meeting
that
shall
not
be
deemed
to
be
in
any
way
my
consent
express
or
implied
in
doing
so.
It's
fraud.
God
bless
her
majesty
the
queen
and
long
live
her
majesty
the
queen.
Let
the
record
show
I
do
not
consent
to
the
unconstitutional
searches
violating
section
8
of
the
Constitution
Act
1982
they're,
currently
taking
place
here
at
Toronto.
City
Hall,
as
the
province
has
never
given
the
City
of
Toronto
Express
statutory
authority.
D
To
do
this
now
I
was
I,
guess
kind
of
expecting
the
Auditor
General
would
actually
be
here
for
this
I.
Don't
so
well,
I!
Guess
we'll
just
go
along
this.
So
when
this
report
it
says
Toronto
Public
Health
has
been
selected,
along
with
other
public
health
units,
to
participate
in
three
significant:
value-for-money
audits,
food
safety,
inspection
program,
audit,
chronic
disease
prevention,
audit,
immunization
audit.
D
Now
something
that
the
Auditor
General
has
said
that
audit
committee,
before
that
I've
never
thought
I'd
hear
someone
at
the
City
of
Toronto
say
and
I
made
up
a
meme
out
of
it.
You
can
see
there.
She
said
my
first
statement
is
always
be
clear
on
the
law,
so
I
just
wanted
to
refresh
your
memory.
That
is
part
she's.
Also
a
lawyer
as
part
of
the
oath
she
took
to
the
Law
Society.
Amongst
other
things,
it
says:
I
shall
not
pervert
the
law.
D
I,
don't
think
she
will
it's
just
the
City
of
Toronto
perverts,
all
all
the
time
and
I
shall
seek
to
improve
the
administration
of
justice.
I
just
want
to
point
out
justice
and
Black's
Law
Dictionary
9th
edition
is
defined
as
the
fair
and
proper
administration
of
laws,
because
in
regards
to
ESPA
the
immunizations
school
pupils
act,
there's
something
about
acts
and
statutes.
This
place
doesn't
really
probably
isn't
aware
of
so
Derrick.
C
D
D
In
the
report
talks
about
the
immunization
act
speaking
on
something
in
the
report,
so
the
M
in
personam
Admiralty
jurisdiction
of
the
federal
court
paper,
which
was
written
by
Chief
Justice
of
the
Court
of
Appeal
for
Ontario,
George
straw.
He
says
Canadian
maritime
law
is
that
body
of
law
defined
in
section
2
of
the
federal
court
act.
That
law
was
the
maritime
law
of
England,
as
it
has
been
incorporated
into
Canadian
law,
and
it
is
not
the
law
of
any
province
of
Canada.
Okay.
D
We
got
that
so
here's
what
it
says
in
trop,
what
a
G
versus
C,
vaca
wire
and
nail
1979
Supreme
Court
of
Canada
Canadian
maritime
law
means
the
law
that
was
administered
by
the
Exchequer
Court
of
Canada
on
its
Admiralty
side
by
virtue
of
the
Admiralty
act
or
any
other
statute.
I
think
we'd
all
agree
that
ESPA
is
a
statute
right
or
that
would
have
been
a
so
administered
if
the
court
had,
on
its
Admiralty
side,
unlimited
jurisdiction
in
relation
to
maritime
and
Admiralty
matters.
D
The
reference
to
the
Admiralty
Act
is
undoubtedly
to
the
Act
of
1934,
but
the
Admiralty
act
of
1891,
although
it
was
repealed,
may
certainly
be
considered
as
any
other
statute
by
virtue
of
which
the
law
was
administered
by
the
Exchequer
court.
On
its
Admiralty
side,
ESPA
immunization
school
pupils
act
any
other
statute.
So
what
exactly
is
the
law?
Well,
I
wrote:
I
got
a
response
back
from
my
former
NPP's
office
about
this
hello,
Derrick
I've
been
in
touch
with
the
Attorney
General's
Office.
D
With
regards
to
your
question,
the
answer
is
that
Ontario
does
not
have
a
civil
code
like
Quebec,
we
have
Rules
of
Civil
Procedure,
but
they
deal
with
procedural
matters.
Only
not
the
substantive
law.
Ontario
is
a
common
law
jurisdiction
and
we
rely
on
the
common
law,
not
a
code.
Please
feel
free
to
contact
us
if
you
have
more
questions
in
the
future.
If
you
guys
are
interested
my
MPP
at
the
time
it
says
there
was
Mike
Cole,
so
he
knows
what
the
law
is.
D
So
I
just
want
to
point
out
it's
by
maritime
law,
the
law
of
the
water
that
applies
to
crew
members
on
somebody
else's
vessel.
In
reality,
we
live
in
a
common
law
jurisdiction
where
the
rules
of
equity
apply.
Also
that's
section
96.1
on
the
Courts
of
Justice
Act,
where
we
live
on
dry
land.
Do
you
see
how
the
two
do
not
jive?
You
cannot
force
maritime
rules
upon
us
when
we're
not
crew
members
on
your
vessel,
so
our
vs.
D
I
need
to
a
legislative
enactment
which
is
unconstitutional
is
akin
to
a
judicial
order
made
without
jurisdiction.
Both
are
made
without
Authority,
just
as
an
accused
can
challenge
a
jurisdiction
of
the
court
to
make
the
order
the
accused
as
alleged
you
of
breach.
That
accuse
can
also
challenge
the
Legislature's
constitutional
jurisdiction
to
enact
the
law.
The
accuses
alleged
Thank,
You
dekuji.
C
C
E
Accordance
with
the
ministry-
and
this
is
from
the
board
of
health
background
well
paragraph
one
in
accordance
with
the
ministry's
published
standards,
protocols
and
guidelines
using
provincial
funding,
which
comes
from
the
taxpayer
and
then
item
seven
Public,
Health
modernization,
paragraph
page,
one
second
paragraph.
We
clearly
heard
and
responded
to
the
need
for
more
extensive
consultations
across
the
province
on
hime
on
how
best
to
move
forward
page
2.
First
paragraph
the
rise
and
unprecedented
emergencies
such
as
Oh
points.
Clearly
Ministry
of
Health
has
not
moved
forward
on
the
overdose
protocol,
which
increases
morbidity
and
mortality.
C
E
Worried
about
the
taxpayer
spending
a
needless
untold
millions
of
dollars,
so
many
left
with
permanent
brain
damage.
Oxygen
deprivation,
you've
taught
millions
of
people,
it
all
started
here:
September
2011
and
it's
been
going
across
the
country
ever
since
thought,
millions
of
people
all
the
science
of
respiratory
emergency
deny
rescue,
breathing,
give
chest
compressions,
still
feeding
heart
and
they're
doing
it
so
I'm
just
wondering
about
accountability.
Who's
accountable!
Is
anybody
gonna
be
held
accountable?
Here's
a
letter
from
the
executive
director
at
Health,
Canada.
E
C
E
I'm
wondering
why
you
haven't
been
audited
all
the
money,
okay,
that
the
taxpayer
is
losing
needlessly.
Thank
you.
Why
even
do
audit
yourself?
Aren't
you
concerned
for
your
own
lives?
Yeah
I
suffer
an
injury
or
illness.
They
put
you
comatose
and
people
are
eagerly
gonna
start
pounding
on
your
chest.
E
C
C
C
Just
before
we
go
on
to
item
HL
13.5,
we
do
have
to
confirm
the
minutes
from
our
meeting
of
2009
2019
director
perks,
move
the
confirmation
of
the
minutes,
all
those
in
favor
opposed
if
any
that
carries.
Thank
you.
So
we
dealt
with
item
13.4
already
so
item
13.5
housing
approaches
that
support
health.
We
have
a
public
speaker
on
this
Derek
you're
registered
to
speak.
D
Just
want
to
point
out
this
is
part
of
an
affidavit
that
was
admitted
into
the
record
by
Justice
Cavanaugh
wendy
on
renee
took
the
police
board
to
court.
This
is
a
City
of
Toronto
lawyer,
telling
Dan
counselor
Mammal
Edie
that,
basically,
when
people
come
to
speaker,
they
can
talk
about
whatever
they
want.
D
I
just
want
to
acknowledge
councillor
Carol
for
eluding.
As
something
I
said.
It's
special
governance
recently
that
nowhere
in
Toronto
City
Council
procedures
is
there
a
rule
that
says
people
who
go
to
speak
at
City
of
Toronto
public
meetings
can't
ask
questions
of
their
public
servants.
So
in
this
report
it
says
recommendations
reinforce
the
need
for
federal
and
provincial
funding
to
allow
City
of
Toronto
to
act
on
its
commitment
to
increase
housing
options
for
Torontonians,
in
particular,
housing
for
vulnerable
populations.
D
Now
I'm
just
about
to
read
a
bunch
of
case
law
on
housing,
so
I
mean
if
you
guys
want
to
check
your
phones
or
computers.
I
won't.
You
know,
I
won't
know
any
different.
Mass
versus
Ontario
Ministry
of
Community
and
Social
Services
1996
Ontario
Superior
Court
divisional
court
said
that
whatever
the
outer
limits
of
the
concept
of
security,
the
person
may
be,
it
must
at
least
involve
having
adequate
food
and
shelter
for
physical
survival.
D
Although
the
question
of
economic
rights
fundamental
to
survival
is
an
open
one
in
the
Supreme
Court
of
Canada,
it
has
been
considered
by
courts
below
that
level.
In
a
number
of
the
above
decisions,
denying
violation
of
section
7,
the
courts
of
approved
statements
made
by
Professor
Peter
Hogg
in
his
constitutional
law
of
Canada
they're
Professor
Hogg,
considered
the
argument
that
security
of
the
person
in
section
7
included
the
economic
capacity
to
satisfy
basic
human
needs
like
housing.
D
He
considered
the
possible
rule
the
courts
in
dealing
with
such
an
argument:
lagravis
versus
Pitt
2008,
Ontario,
Superior
Court
in
Yin
versus
Lewin
justice,
rook
also
said
again
referring
to
Hogg
as
Authority.
Moreover,
the
right
to
security
of
the
person
under
Section
7
does
not
include
Economic
Security,
except
perhaps,
to
the
extent
of
economic
capacity
to
satisfy
basic
human
needs
again,
like
housing,
Singh
versus
minister
of
employment
and
immigration,
1985
Supreme
Court
of
Canada,
like
Liberty,
the
phrase
security
of
the
person
is
capable
of
a
broad
range
of
meaning
the
phrase
security.
D
The
Commission
went
on
and
described
the
provisions
of
necessaries
in
terms
of
article
25,
paragraph
1
of
the
Universal
Declaration
of
Human
Rights,
which
reads
everyone
has
the
right
to
a
standard
of
living,
adequate
for
the
health
and
well-being
of
himself
and
of
his
family,
including
food
clothing,
housing.
If
housings
are
right
like
where
do
we
ever
get
it
into
our
heads
that
we
had
to
pay
for
it?
D
If
it's
a
right,
we
shouldn't
have
to
pay
for
it
to
begin
with,
and
medical
care
and
necessary
social
services
and
the
right
to
security
and
the
event
of
unemployment,
sickness,
disability,
widowhood
old
age
or
other
lack
of
livelihood
and
circumstances.
Beyond
his
control,
commentators
have
advocated
the
adoption
of
a
similarly
broad
conception
of
security.
The
person
in
interpretation
of
section
7
of
the
Charter
reference
regarding
sections
193
and
195
point
1,
1
C
of
the
Criminal
Code
Manitoba
1990
needs
Supreme
Court
of
Canada.
D
In
order
to
give
section
7
that
interpretation,
security
of
the
person
must
be
interpreted
to
mean
the
economic
capacity
to
satisfy
basic
human
needs
like
housing,
that
is,
to
earn
a
living.
Nowhere
in
section
7
is
there
reference
to
property
rights,
and
that
omission
is,
in
my
opinion,
significant.
It
should
be
noted
that
the
court
expressly
stated
that
it
was
not
deciding
that
section.
7
could
not
apply
to
any
interests
which
has
an
economic
commercial
property
component.
D
Another
case
from
British
Columbia
Whitbread
versus
Walley
1988
BC
Court
of
Appeal
also
dealt
generally
with
the
question
of
economic
interests
in
section
7
of
the
Charter
Justice
Jay
a
just
associated
justice
in
McLaughlin,
as
she
then
was
speaking
for
the
court
held
at
page
213,
that
purely
economic
claims
are
not
within
the
purview
of
section
7
of
the
Charter,
although
she
did
add
the
caution
that
she
was
not
asserting.
That
section
7
could
never
include
an
interest
with
an
economic
component.
D
C
You
alright,
are
there
any
other
speakers
on
this
item.
Okay,
seeing
no
we're
gonna
move
this
into
committee.
Questions
of
staff
I
have
a
couple
just
very
briefly:
do
we
and
I'll
direct
this
to
IC?
We
have
staff
here
from
shelter,
supported
housing
administration
as
well,
so
to
our
MOH
or
the
direct
are
from
shelter,
support
and
housing
administration.
Does
the
City
of
Toronto
have
been
a
target
for
how
many
new
units
of
supportive
housing
to
build?
Yes,.
C
F
C
H
So
through
the
chair,
thank
you
for
the
question.
So
again
we're
population
health
service
right
and
we
work
in
public
health,
so
our
areas
tend
to
be
more
around
first,
a
for
most
population
health
assessment
and
actually
talking
about
and
appreciating
and
understanding
the
health
impacts
of
under
housing
and
homelessness
in
respect
of
our
population.
So
I
would
say
first
and
foremost,
that's
where
we
are
involved
in
what
I
would
characterize
the
diagnosis.
We
also
work
quite
actively
with
our
shelter,
support
housing.
H
Colleagues,
particularly
around
infection
prevention
and
control
aspects
within
the
context
of
congregate
settings,
and
we
have
a
long
and
established
history
working
with
our
partners
there.
We
do
have
some
other
teams
community
to
with
community
development
officers
that
do
some
very
specific
work
with
particular
populations.
But
much
of
the
service
that's
provided
is
through
our
colleagues
at
s
sha
and
through
community
agencies
as
well.
But
that
gives
you
a
bit
of
a
high
level
overview.
A
F
A
F
B
Following
up
on
a
director
Mulligan's
question
regarding
public
health
responsibilities,
if
it's
not
the
responsibility
of
public
health
to
provide
on-site
supports
to
the
tenant
population
who
needs
support
of
the
additional
wraparound
supports,
whose
responsibility
is
it
and
what
order
of
government
should
be
funding
it?
So.
H
Through
the
chair,
when
we
talk
about
supportive
housing
and
we're
talking
about
health
care
supports
in
particular
that
would
fall
under
the
purview
of
the
ministry,
so
a
number
of
those
supports
are
indeed
health-related
care
related.
Let
me
be
very
clear
about
that.
Hence
I
would
see
the
provincial
government
being
the
appropriate
partner
with
whom
to
follow
up
and.
H
B
The
Ministry
of
Health
themselves
don't
deliver
the
service
on
the
front
lines.
They
would
be
funding,
organizations
that
are
community
based
mental
health
oriented
they
would
be
funding
the
Ontario
Mental
Health
Oh
such
as
CAMH.
What's
their
responsibility
when
the
money
comes
from
the
Ministry
of
Health
provincially,
which
organization
should
be
in
the
in
the
physical
buildings
providing
contact
direct
service
to
those
social
tenants.
So.
H
Through
the
chair,
there
are
a
number
of
different
agencies
that
provide
those
services
so
and
we
are
actually
any
what
I
would
characterize
is
as
a
bit
of
a
cheat
a
period
of
transformation
and
flux
within
healthcare.
So
what
happens
is
that
we
have
very
briefly
the
Ministry
of
Health
who,
in
turn
until
recently,
has
funded
the
local
health
integration
networks,
who
are
in
turn
responsible
for
flowing
funds
to
community
agencies.
That
system
is
is
in
flux
for
lacks
a
lack
of
a
better
term.
H
We
used
to
have
14
local
health
integration
networks,
we're
now
down
to
I,
believe
it's
five
regional
offices
all
run
under
Ontario
health,
but
suffice
it
to
say
that
the
funding
for
community
agencies
that
deliver
those
kinds
of
healthcare
services
in
the
community
does
come,
at
least
in
part
through
the
Ministry
of
Health
I.
Imagine
that
some
of
them
get
some
funding
through
other
ministries
or
other
routes
as
well.
H
But
I
would
also
point
out
that
there
is
home
care
that
has
traditionally
been
run
through
the
CC
ACS,
which
were
community
and
community
care
agencies
that
have
traditionally
been
under
the
purview
of
those
local
health
integration
networks
and
again,
that's
all
rather
very
much
in
transformation
and
flux.
Right
now.
But
that's
where
the
funding
has
gone
through.
H
Through
the
chair,
that
is
also
the
healthcare
system,
and
I
would
suggest
to
you
that,
based
on
my
knowledge,
there
is
actually
not
very
much
that
happens
within
the
context
of
housing.
There
is
a
healthcare
system
that
actually
requires
that
people
go
to
healthcare
facilities
to
make
a
veil
of
those
services.
B
And
finally,
because
recommendation
2
says
that
we
should
be
urging
the
federal
and
provincial
governments
to
increase
funding
to
community
based
organization,
health
care
providers
and
so
forth.
What's
the
role
of
the
federal
government
so
far,
because
you've
highlighted
a
lot
of
what
the
province
is
supposed
to
do?
What's
the
federal
government
supposed
to
do
through.
H
The
chair,
I
think
the
federal
government
has
a
number
of
different
roles
to
play
here,
certainly
with
respect
to
the
National
Housing
Strategy
and
outlining
a
framework
for
which
in
which
these
services
can
be.
So
you
have
housing
and
services
considered
as
part
and
parcel
I
think
when
it
comes
to
issues
around
managing
substance,
use
and
challenges
related
to
substance
use.
H
B
C
Are
there
to
speak
all
right,
I'm
gonna,
put
myself
on
the
listen
if
I
could
move
an
amendment
which
is
can
be
placed
on
the
screen
to
request
the
medical
officer
of
health
and
consultation
with
the
deputy
city
manager
and
GM
of
our
shelters
for
housing,
division
and
housing
secretary
to
report
to
the
April
meeting,
with
details
of
the
city's
new
plan
to
create
600
supportive
housing
units
every
year.
So
let
me
just
walk
through
that
a
bit,
as
the
report
spoke
to
on
every
rung
of
the
housing
ladder.
C
People
are
stuck
so
for
the
8,000
people
within
our
homeless
population
if
they
have
access
to
a
shelter
they're,
often
stuck
without
being
a
legs
at
the
shelter
for
the
15,000
people
on
the
waiting
list
for
supportive
housing.
There
aren't
units
to
get
to
for
the
hundred
and
eighty
one
thousand
people
on
the
waiting
list
for
subsidized,
affordable
housing.
C
That
list
is
getting
longer
not
shorter
and
we
have
a
strain
and
exceptionally
strange
rental
housing
market
with
increased
evictions
and
renovations
driving
people
down
the
ladder
and
so
housing
writ
large
affects
the
health
of
Torontonians
and
I'm.
Grateful
that
our
medical
officer
of
health
is
continuing
to
bring
forward
reports
on
this
matter.
Supportive
housing
is
one
critical
piece
and
it's
a
critical
place
where
I
think
Toronto
Public
Health
has
a
key
role
to
play,
both
in
terms
of
advice
to
give
and
perhaps
involvement
in
it.
C
And
so
two
years
ago
the
City
of
Toronto
set
a
target.
We're
gonna
build
1,800,
supportive
housing
units
a
year
for
10
years.
We
have
not
been
meeting
that
target,
but
we
set
a
target.
Two
months
ago,
city
council
directed
city
staff
to
come
up
with
a
plan
to
create
600
units,
one
third
of
those
1,800
per
year
for
the
city
to
come
up
with
a
plan
to
create
six
hundred
units
a
year
every
year,
starting
in
2020.
That
plan
will
be
coming
to
the
Planning
and
Housing
Committee
here
at
the
city
in
February,
I.
C
Think
it's
important
that
this
board
considers
that
plan
and
considers
any
role.
We
might
play
an
advice
we
might
provide
or
recommendations
as
well
and
so
that
the
impetus
behind
this
so
in
April,
we
will
be
looking
at
the
city's
new
plan
to
create
these
units.
On
an
annual
basis
and
I
hope,
it's
a
great
plan
but
I'm
looking
forward
to
the
medical
officer
of
Health,
giving
us
her
advice
on
it.
Those
are
all
my
comments.
Are
there
any
other
speakers?
Okay,
Oh
question
are
speaking
speaking
speaking:
yes,
okay,
yeah.
G
I
wanna
support
of
this
motion
and
to
suggest
that
part
of
the
role
of
assessment
could
be
excuse
me
for
Toronto
Public
Health
to
include
health
assessment
as
the
City
of
Toronto
takes
on
building
of
supportive
and
affordable
housing.
That
assessment
of
health
impacts
and
health
systems
costs
and
savings
should
be
an
important
consideration.
C
B
I
was
just
in
in
conversation
with
the
medical
officer
of
Health
I.
Think
because
there's
a
report
that
deals
with
this
matter
are
going
to
planning
and
what
I'd
like
to
do
is
take
the
staff
report.
That's
going
to
be
generated
from
at
believe
Gore's
office
or
the
housing
secretary
directed
to
the
medical
officer
of
Health,
so
that
she
can
perhaps
put
the
health
lens
over
that
report
and
bring
it
back
to
this
committee.
B
C
B
C
B
C
C
I
Thank
you
good
morning.
This
is
a
presentation
on
the
Ministry
of
Health's
consultation
on
public
health
in
November
of
2019,
the
Ministry
of
Health
announced
a
consultation
with
stakeholders
to
inform
their
view
of
public
health.
At
the
same
time,
the
Ministry
released
a
report
for
consultation
called
public
health
modernization.
This
presentation
is
to
update
you
on
the
consultation
and
to
provide
information
for
consideration
in
a
response.
The
consultation
process
kicked
off
in
November
and
lasts
hilum
proximately
February
of
this
year.
I
It
consists
of
two
parts:
first,
an
in-person
meeting,
that's
being
held
across
the
province
with
various
health
units
boards
and
their
senior
staff.
Our
meeting
is
scheduled
for
February
10th.
The
other
part
of
the
consultation
is
a
survey
its
online
twenty
one
questions
and
it's
open
until
February
tenth
to
gather
information
for
the
survey
we
held
an
all-day
workshop
in
December,
to
which
all
management
and
frontline
staff
were
invited.
I
We've
taken
the
information
from
that
good,
hearty
discussion
and
summarized
it
along
with
internal
staff
survey
that
includes
all
21
questions
and
that
our
staff
can
give
input
to,
and
then
we
could
summarize
for
our
response,
because
the
survey
is
open.
We've
encouraged
our
staff
to
respond
as
teams
to
respond
through
their
professional
associations
and
Trin's
respond
as
individuals.
So
essentially
that's
the
consultation
as
we
know
it.
Now
there
are
public
meetings,
ours
being
February
10th
and
there's
an
online
survey
to
respond
to
the
survey.
I
It's
useful
to
look
at
previous
reports
that
have
reviewed
the
function
of
public
health.
There
are
many
I've
listed
a
few
here,
some
of
which
will
be
familiar
to
you
because
they
came
after
major
events
such
as
SARS
and
h1n1.
The
titles
are
revealing,
they
all
speak
to
some
form
of
revitalization
or
renewal,
and
they
all
have
a
call
to
action
to
strengthen
public
health.
A
review
of
these
reports
shows
that
the
recommendations
boil
down
into
two
main
areas.
I
The
first
is
public
health
as
a
system
not
as
a
narrow
delivery
agent
of
a
small
number
of
programs,
but
a
system
unto
itself.
The
second
set
of
recommendations
all
speak
to
characteristics
or
principles
that
will
strengthen
public
health
as
a
system,
so
in
the
next
few,
slides
I'll
go
through
how
these
reports,
written
by
public
health
leaders
over
the
years,
characterize
public
health
as
a
system.
I
It's
helpful
to
look
at
public
health
in
comparison
to
the
other,
very
large
system
in
health,
the
health
care
system
which
dr.
Davila
was
speaking
to
earlier,
and
to
understand
how
we
are
distinct
and
different,
but
how
individuals
do
flow
between
these
two
systems.
So,
for
example,
an
individual
in
the
community
may
have
contracted
tuberculosis
have
been
picked
up
through,
as
dr.
Davila
was
mentioning
our
assessment
surveillance
function
and
then
move
into
care
in
an
institution.
I
But
there
are
many
other
functions
listed
there
that
we
do
and
we
are
always
concerned
not
with
just
individuals
but
with
whole
populations
with
subpopulations
such
as
schools
and
we're
concerned
with
them
throughout
their
entire
lifetime,
and
we
do
many
different
functions
and
interventions
rather
than
the
narrow
function
that
healthcare
as
a
system
provides.
So
that's
the
first
message
that
the
leaders
in
public
health
brought
forward
in
these
reports,
and
that
is
that
we
have
a
broad
range
of
functions
that
we
need
to
provide
as
a
system.
I
The
second
major
theme
that
they
brought
forward
was
that
we
work
with
a
broad
range
of
organizations
and
by
work
with
I
mean
in
a
formal
sense.
We
can't
do
our
work
unless
we
are
in
a
formal
relationship
and
moving
information
or
understanding
context
with
particular
organizations.
I
mentioned
this,
because
the
survey
asks
quite
specifically
how
we
can
work
our
closely
with
healthcare
or
social
services.
I
That
has
to
be
done
in
close
partnership
with
those
particular
departments,
but
also
with
community
organizations
that
have
listed
their
who
sometimes
are
the
third
party
deliverers
of
our
program,
so
sometimes
we're
funding
community
organizations
to
provide
nicotine
replacement
therapy
or
smoking
cessation
in
high-risk
communities.
We
also
are
legislated
to
work
with
organizations
such
as
daycare.
So
that's
the
second
big
theme
that
there
is
a
wide
variety
of
organizations.
We
need
to
work
with
the
next
theme
that
comes
out
from
these
reports.
I
It's
helpful
to
understand
how
our
particular
interventions
are
different
than
health
care
system.
Where,
again,
the
focus
is
an
individual
who
brings
himself
in
need
of
care
is
assessed,
diagnosed
treated
or
counseled,
whereas,
in
contrast,
if,
for
example,
an
individual
is
seeking
support
through
public
health,
they
sometimes
are
coming
from
health
care.
So
say
we
have
an
individual
who's
been
diagnosed
with
the
heart
condition
and
needs
to
quit
smoking.
I
Successful
smoking
cessation
happens
when
you
have
supportive
environments
that
are
smoke-free
both
workplace
in
public
and
then
because
we
are
concerned
with
people
throughout
their
lifetime.
We
would
also
be
reaching
out
to
family
members,
such
as
the
children
in
that
family,
to
give
them
information
schools
to
make
sure
that
schools,
property
are
smoke-free
through
our
inspection
process
and
to
make
sure
that
retail
advertising
and
tobacco
is
within
the
legislation.
I
This
final
area
that
I've
depicted
here
relates
to
accountability.
So
the
survey
asks
questions
about
our
roles:
printer
role,
the
local
field
role
and
the
role
of
Public
Health
Ontario.
The
reports
don't
spend
a
lot
of
time
and
roles
and
if
they
feel
that
they're
articulated
clearly
now,
but
they
do
speak
to
the
challenge
of
both
individual
accountability
for
our
role
as
well
as
accountability
that
we
have
for
the
whole
system
to
the
public.
I
So
what
they
mean
by
that
is
that
when
there
is
a
problem,
it
isn't
enough
for
us
as
the
field
to
just,
for
example,
with
vaping
report
that
we've
done
an
assessment.
We
see
vaping
increase
and
we're
going
to
provide
local
bylaw.
You'll
recall
that
in
the
report
we
brought
forward
about
vaping.
We
also
brought
forward
the
evidence
around
availability,
the
appealing
nature
of
flavored
to
vaping
products,
as
well
as
advertising,
so
again
we're
bringing
forward
the
research
and
we're
bringing
the
accountability
in
that
case
to
the
province
and
the
feds.
I
So
the
point
being,
as
expressed
in
the
last
couple
of
bullets,
because
local
context
and
an
emerging
issue
like
vaping
are
important
to
being
effective.
We
need
to
be
working
in
a
mutual
respectful
working
relationship
with
the
province
and
a
shared
responsibility
for
the
public's
health.
It
would
not
have
been.
I
That
has
to
pass
the
ball,
but
really
at
the
end
of
the
day,
is
accountable
to
the
public
for
how
we
work
well
together,
and
we
certainly
saw
in
particular
in
the
Czar's
report,
how
we
needed
to
do
that
work
more
more
cooperatively
and
set
up
systems
to
support
us.
So
that's
what
the
next
two
slides
get
at.
If
we
are
to
work
as
a
team,
there
needs
to
be,
if
you
will
a
game
plan
that
is
developed
jointly.
We
can
strengthen
this
area
by
looking
at
the
work.
I
That's
done
in
Quebec,
where,
instead
of
having
standards
that
then
are
implemented
by
the
province
and
a
kind
of
an
us-and-them
relationship,
the
provincial
medical
officer
of
Health
Chief
met
a
cost
of
health
with
leaders
from
each
of
the
major
health
unit
areas
and
develops
a
10-year
plan.
So
if
it
was
15
years
ago,
this
plan
would
include
the
need
to
create
smoke-free
workplaces,
bylaws
for
smoke-free
public
places
and
then
eventually
the
smoke-free
provincial
legislation
as
an
example,
along
with
all
the
other
areas
that
that
we
have
jurisdiction
over.
I
But
you
can
see
how
it
doesn't
make
sense
to
develop
individual
plans
across
the
province,
but
for
some
areas,
such
as
tuberculosis,
we
would
have
individual
priorities,
because
tuberculosis
is
an
issue
for
Ottawa
and
Toronto,
not
so
much
for
rural
Ontario
here
in
County
or
graters.
So
there
needs
to
be
a
balance
between
individual
context,
attention
paid
to
priorities
as
well
as
priorities
that
are
best
done
across
the
province
in
a
coordinated
way.
Interestingly,
in
Quebec
after
they
do
this
ten
year
plan
the
individual
they
call
the
region's
there.
I
In
our
case,
it
would
be
the
a
Health
Unit
areas
develop
a
local
response
again
getting
at
what,
in
their
context,
is
the
best
way
to
apply
in
our
case
of
a
thing
would
be
an
example
where
we've
got
a
lot
of
vaping
outlets
in
a
more
rural
area
that
wouldn't
have
as
many,
but
they
may
have
an
underground
market.
So
there
needs
to
be
localization,
but
there's
a
commitment
to
implement
that
plan
and
resources
are
matched
to
it.
I
So
that's
the
what
then,
similarly
for
the
how
we
need
a
mechanism
to
come
together
to
plan
when
we
are
going
to
have
a
particular
issue,
research,
so
that
we
know
the
evidence
and
we're
not
doing
it
a
duplication.
But
we
need
a
mechanism
to
organize
that
we
have
this
now
to
a
certain
extent.
For
some
issues
it
certainly
could
be
strengthened,
but
we
again
need
to
strike
that
balance
between
local
adaptation
and
when
we
want
to
work
together
as
a
province.
I
So
a
local
health
that
unit
area
may
want
to
pilot
a
particular
new
initiative
for
scaling
up
in
the
province
or
we
may,
as
I
mentioned
with
tobacco.
Legislation,
may
want
to
have
individual
health
departments
work
together
to
create,
as
it
was
done
with
tobacco,
local
policy
bylaws
and
then
work
towards
the
provincial
change.
So
there's
a
pattern
there
where
we
can
work
both
independently
and
collectively.
I
Stakeholders
was
an
area
that
I've
mentioned
before
or
in
this
presentation
that
they
emphasize
that
they
are
part
of
how
we
do
our
work,
not
just
a
casual
partner
and
sufficient
work
force.
Who
are
able
to
do
this
local
customization
and
then
knowledge
to
practice
function
are
two
other
areas
that
the
reports
mentioned
for
a
strong
public
health
system.
I
The
final
areas
are
quite
clear
and
in
terms
of
the
experience
that
you've
had
here
at
this
board,
one
being
stable,
predictable
funding
and
the
other,
this
concept
of
both
independent
accountability
as
a
field
or
as
the
province,
but
also
joint
accountability
for
how
well
we
work
together
to
protect
and
promote
the
public's
health.
So,
in
summary,
all
of
these
previous
reports
added
visions,
some
form
of
revitalization.
I
Some
of
the
recommendations
have
been
implemented.
So
we
have
two
major
public
health
agencies
now
that
we
didn't
have
before
SARS
one
being
Public
Health
Ontario,
the
provincial
agency
and
public
health
agency
of
Canada,
which
is
the
Canadian
equivalent
of
the
Center
for
Disease
Centers
for
Disease
Control
in
the
US.
So
those
are
good
accomplishments.
Based
on
these
reports
that
were
previously
written,
this
public
consultation
with
the
province
offers
us
the
opportunity
to
realize
even
more
of
these
recommendations
that
were
identified
by
leaders
in
the
field.
H
So
yes,
if
I
may
just
wrap
up
the
presentation,
Thank
You
Gayle
for
providing
that
presentation
and
I
hope
it
pros,
provided
members
of
the
board
with
some
points
and
principles
and
thoughts
for
consideration
as
the
Ministry
of
Health
embarks
on
its
consultation
process.
Just
to
reiterate
a
couple
of
points
that
were
made
in
the
in
within
the
presentation
itself
that
the
province
is
currently
holding
an
open
public
consultation
process
in
respect
of
Public
Health
modernization.
H
This
is
the
process
that
they've
undertaken
and
that
survey
is
in
fact
open
to
all
members
of
the
public
and
to
our
knowledge,
what
has
been
put
out
there
is
that
the
that
survey
is
open
until
the
10th
of
February.
We
are
also
in
conversation
with
the
province
right
now.
We
understand
that
they're
working
towards
a
February
10th
consultation
date
with
the
City
of
Toronto,
just
to
be
clear,
their
modernization
processes
the
province
has
described.
It
is
not
just
with
respect
to
public
health.
H
They
are
also
doing
a
consultation
process
around
the
province
in
respect
of
emergency
health
services.
So
the
province
is
currently
proposing
to
hold
a
in-person
consultation
session,
with
the
City
of
Toronto
on
February
10th,
half
of
the
day,
covering
Public,
Health
and
half
of
the
day
covering
emergency
health
services
or
paramedics.
So
that's
the
our
understanding
of
the
consultation.
We're
still
working
through
some
of
the
details
are
waiting
to
hear
with
respect
to
what
the
province
has
in
mind
for
that
consultation
session,
but
we're
certainly
once
we
have
something
a
little
more
confirmed.
H
J
Thanks
future,
thank
you
for
this
great
presentation.
On
page
12,
you
talk
about
the
Quebec
model.
So
can
you
just
help
me
understand
the
differences
between
Quebec
and
Ontario
a
little
bit
more,
so
I
think
what
I
heard
you
say
is
that
in
Ontario
we
have
legislated
standards
and
in
Quebec
it's
a
little
bit
different
in
that
they're
not
legislated
and
they're
co-developed.
Is
that
correct
sure.
I
You
can
see
where
there's
strengthened,
having
a
coordinated
approach
across
the
province,
so
that
did
happen
with
tobacco
and
it
happened
in
part
because
of
leaders
in
the
province
and
leaders
locally,
who
came
together,
but
it
was
more
ad
hoc
and
less
formal,
whereas
in
Quebec
as
I
understand
their
system,
they
do
have
a
similar
system
of
agreed
set
of
goals
or
standards,
but
they
also
have
this
approach
of
a
10
year
plan
where
they
look
at
particular
issues.
And
you
know
there
are
many
many
issues.
I
I
just
chose
tobacco
because
it's
simple
to
understand
tobacco
15
years
ago
needed
work
to
create
the
current
bylaws
in
tobacco.
Legislation
that
we
have
vaping
is
in
the
same
situation.
Now
we
need
to
work
as
a
system
and
that
where
this
concept
of
joint
accountability
comes
in
so
firmly
so
I'm
suggesting
that,
rather
than
having
an
ad
hoc
approach,
issue-by-issue
with
tobacco
or
with
the
communicable
disease,
that
we
create
a
system
where
we
formally
create
a
plan
for
a
period
of
time
commit
to
local
implementation
in
the
world.
J
J
Okay
and
back
to
the
Ontario
public
health
standards
and
because
they're
because
they
exist
in
legislation
and
provincial
legislation-
and
you
said
there
is
some
local
interpretation-
is
there
the
static
nature
of
that?
Does
that
impact
Toronto,
Public
Health
ability
to
be
responsive
on
the
ground
through.
I
The
chair,
the
wording-
that's
in
the
standards
varies
depending
on
the
research
for
a
particular
issue.
So
sometimes
we
know
exactly
what
the
intervention
needs
to
be
and
there's
a
protocol
very
tightly
written
for
it
exists.
It
tends
to
exist
in
the
clinical
services
such
as
beautiful
diseases
or
in
dental
and
others.
The
verbs
that
are
used
are
broader,
so
it
would
be
in
collaboration
with
community
groups,
ensure
that
accident
happen.
So
there's
a
range
of
verbs.
I
K
I
just
want
to
make
sure
I
understand
the
policy,
development
or
action
development
process.
You
seem
to
be
recommending
so
you're
saying
have
it
have
a
province-wide
plan,
but
customized
locally?
Is
that
yeah?
So
I
have
a
question
concern
about
that
so
I,
one
of
the
things
that
I
think
has
been
remarkable
about
Toronto
Public
Health,
is
that
on
many
issues
smoking
included
the
Toronto
Public
Health
System
has
been
able
to
advocate
for
things
that
the
province
is
not
yet
taken
on.
K
You
mentioned
smoking,
so
I
remember
many
years
when
the
Toronto
Board
of
Health
was
advocating
for
removing
for
getting
smoking
out
of
bars
and
restaurants
and
workplaces
well
before
the
province
considered
a
problem.
Similarly,
the
pesticide
bylaw,
actually
the
province
actively,
was
a
problem
when
we
were
doing
that.
So
do
you
see
a
role
in
the
system
you're
advocating
for
for
local
health
units
to
generate
issues
that
are
not
priorities
province-wide
so.
I
In
short,
yes
and
I'm
not
suggesting
this
is
the
only
way,
I
just
think
and
really
I'm
reporting.
What
the
reports
that
reflected
on
how
public
health
could
function
well
suggested.
There
may
be
other
ways
to
get
there,
but
it
would
do
exactly
what
you're
suggesting
locally.
We
have
a
role
in
us
in
surveillance
and
assessment
and
when
we're
seeing
something
like
vaping
rates
or
as
you
mentioned
previously
with
tobacco,
we
have
a
responsibility
to
report
and
to
look
at
the
literature
and
see
what
is
the
most
effective
way
to
affect
that.
I
In
the
case
of
vaping,
as
I
mentioned,
one
of
the
effective
routes
to
go
is
to
deal
with
availability,
flavors
and
advertising
again
outside
of
our
jurisdiction,
but
we
certainly
brought
forward
that
recommendation.
So
I
would
say
I'm
in
agreement
with
what
you're
proposing,
because
we
have
a
role
to
reflect,
what
we're
seeing
in
the
community
and
what
we
know
works
in
the
literature
and.
H
The
history
that
you
talked
about
with
respect
to
Toronto
I
think
what's
interesting
about
that,
is
that
yes,
Toronto
has
always
played
a
leadership
role
in
that
regard
and
that
that
has
been
augmented
and
been
most
successful
in
the
province
when
it's
Toronto
and
Waterloo
and
Peele
and
Durham
and
Ottawa
it's
it's
the
local
partners
together
that
actually
bring
that
real
strength
and
that
make
for
that
change.
That
needs
to
happen
and
has
happened
in
the
past
at
the
province.
G
G
There
are
a
few
things
that
are
either
asked
about
in
the
discussion
paper
issued
by
the
province,
or
you
know
that
I
think
are
important
to
the
Mandate
of
Toronto
Public
out
that
aren't
mentioned
here.
So
one
of
them
is
health,
equity,
I,
I,
don't
see
this
mention
directly
in
the
paper
and
so
I
guess.
My
first
question
would
be
what
is
the
role
of
local
public
health
and
the
public
health
system
in
advancing
health
equity.
H
So
through
the
chair,
people
who've
heard
me
speak
on
what
the
role
and
objectives
of
public
health
are
are
probably
tired
of
hearing
me
say
this,
but
I'm
going
to
say
it
anyway,
when
I
think
about
public
health
and
when
we
think
about
that
which
we
have
to
do
here
at
Toronto
and
I
would
say
public
health
system
writ
large.
We
have
three
major
objectives.
The
first
is
to
improve
the
health
status
of
the
population.
H
The
second
is
to
reduce
disparities
in
the
health
status
of
the
population,
and
the
third
is
to
prepare
for
and
respond
effectively
to
outbreaks
and
emergencies,
so
by
definition,
health
equity
has
to
be.
It
is
part
and
parcel
it's
in
the
DNA
of
Public
Health
and
it's
one
of
our
fundamental
objectives.
So
it's
throughout
all
aspects
of
Public,
Health,.
G
G
H
Yes,
so
through
the
chair,
I
think
there
are
a
couple
of
different
things.
So
sometimes
there
are
areas
that
are
within
the
context
of
a
given
municipality
and
for
others
of
our
partners,
a
local
public
health
response
is
not.
You
know,
you
know
exclusive
to
one
particular
municipality.
It's
a
series
of
different
municipalities
working
together,
so
it's
it
depend
on
context.
G
H
Through
the
chair,
an
interesting
question
and
one
that
actually
has
a
number
of
different
nuances
to
it,
and
it
all
depends
on
which
function
we're
talking
about.
There
are
some
times
where
we
need
to
actively
share
individual
level
information
in
order
to
best,
protect
and
promote
the
health
of
the
population.
There
are
other
times
when,
in
fact,
all
we
need
is
aggregate
data,
non
nominal
aggregate
data,
so
I,
don't
think,
there's
a
one-size-fits-all
solution.
H
There
I
think
we
need
to
have
a
supportive
technological
environment
that
actually
facilitates
the
ability
of
all
partners,
whether
they're
within
the
public
health
system
or
whether
they're
within
the
healthcare
system
and
for
the
interaction
between
those
two
systems.
We
need
an
environment
that
actually
facilitates
the
ability
for
all
of
us
to
do
our
job
and
what
that
looks
like
actually
varies,
depending
on
which
circumstance
we're
looking
at.
G
My
next
question
is
about
there's
a
mention
here:
developing
defining
a
formal
working
relationship
between
Ontario
health
teams,
public
health
and
municipalities
and
I
noticed
that
the
discussion
paper
asks
particularly
about
deepening
relationships
with
primary
care.
So
can
you
tell
me
a
little
bit
about
what
that
role
might
ought
to
look
like
from
a
public
health
perspective,
so.
H
Through
the
chair
you
know,
I
don't
have
I,
don't
think
I
have
an
exclusive
purview
over
that.
Certainly
I
have
some
influence.
The
Ontario
Health
teams
are
very
much
in
development,
so
I
think,
and
each
of
them
is
taking
its
own
unique
character
and
role.
I
do
believe
that
when
we
look
at
public
health,
there
are
particular
areas
where
we
need
to
have
effective
communication
and
interaction,
particularly
with
primary
care,
in
the
case
of,
for
example,
work
that
has
to
do
with
individual
communicable
disease
case
management.
We
have
an
important
role
there.
H
When
we
have
emerging
new
infections,
we
have
an
important
role
there.
Certainly
in
respect
of
immunization,
we
have
important
interactions
that
need
to
occur
with
primary
care
providers
and,
to
a
certain
extent,
in
terms
of
having
conversations
around
what
is
actually
impacting
on
the
health
status
of
the
population.
New
and
emerging
health
issues,
I
think
there's
an
important
role
to
have.
However,
I
do
think
it's
important
as
well
to
distinguish
that
which
is
public
health
from
that,
which
is
health
care,
primary
care.
Being
one
aspect
of
that,
and
that's
a
there's
much
more.
H
We
could
speak
to
on
this
issue,
but
there
is
I,
see
them
as
complementary,
but
not
entirely
similar
roles,
and
there
are
certain
areas
where
we
need
to
have
greater
integration
and,
frankly,
some
areas
where
our
work
may
be
quite
separate
from
each
other
and
I.
Think
with
as
the
Ontario
Health
teams
develop
our
the
nature
of
our
relationship
that
we
would
have
as
the
local
Public
Health
Unit
may
be
quite
different
from
one
to
the
next,
depending
on
what
the
nature
of
the
Ontario
Health
Team
is
just.
G
Ask
one
last
question:
if
that's
okay,
with
respect
to
just
going
back
to
the
there's
a
mentioned
explicit
messaging,
around
indigenous
health
and
francophone
health
in
particular,
has
two
priority
groups
so
from
the
perspective
of
Toronto
Public
Health
is
the.
Would
you
support
the
principle
of
indigenous
health
in
indigenous
hands?
It's
worth
a
chair.
Yes,
thanks.
B
H
So
through
the
chair,
it's
not
that
all
data
is
aggregate.
We
talked
about
data
strategies
in
a
data
environment
that
actually
supports
the
right
data
at
the
right
level,
depending
on
what
the
function
is
so
fundamentally,
health
equity
is
built
in
and
it's
actually
one
of
the
core
objectives
of
Public
Health.
We
are
if
we
improve
health
status
of
the
population,
but
do
so
in
a
manner
that
actually
increases
disparity
in
health
status.
Then
then,
frankly,
I
would
have
to
tell
you
that
we
have
failed
or
we're
not
doing
our
job
sufficiently.
H
So
I,
don't
think.
As
I
was
in
the
previous
answer,
I
gave
there
isn't
a
one-size-fits-all
solution.
It's
a
question
of
what
issue
are
we
trying
to
resolve
with
whom
do
we
need
to
partner
and
collaborate
in
order
to
effectively
come
to
resolution
on
that
issue,
and
therefore
what
data
do
we
need,
and
each
of
those
situations
will
be
different?
H
We
talked
a
lot
about
healthcare
and
the
need
to
exchange
particular
information
with
healthcare
providers,
but
it
may
be
just
as
important
to
share
information
with,
for
example,
our
colleagues
at
s
sha,
just
as
an
example.
So
we
need
to
think
about
a
data
system
in
an
environment
that
actually
and
technology
that
supports
those
different
functions
and
the
exchange
of
information
at
the
appropriate
level
with
the
right
partners
and.
H
They
are
not
always
the
most
flexible
they
are.
They
don't
always
provide
all
the
functions
that
we're
looking
for
and
I
think
that
this
is
one
of
those
issues
where
we
have
an
opportunity
to
engage
with
our
provincial
partners
to
talk
about
the
kinds
of
systems
we
need
across
the
province
and
how
we
come
up
with
systems
and
environments
and
legislation
and
and
regulations,
etc,
and
technology
that
actually
allows
for
the
flexibility
that
we
need
to
manage
priorities
that
exist
across
the
province,
but
in
a
way
that
respects
the
local
context.
Just.
B
H
B
H
Clear
I
think
through
the
chair,
the
details
are
still
very
much
being
worked
out
and
the
province
has
held
a
few
of
these
sessions
already
and
frankly,
each
one
has
been
slightly
different
one
from
the
next,
because
they're
I
think
learning
as
they
go
along
and
I
think
that's
fair
to
say.
So.
Our
understanding
is
that
they
would
like
to
hold
local.
A
local
consultation
here
with
the
City
of
Toronto
and
half
of
the
day
would
be
dedicated
towards
Public
Health.
H
B
H
Through
the
chair,
my
understanding
is
that
in
other
jurisdictions
it
has
not
been
a
special
meeting
of
the
Board
of
Health.
It
has
been
a
meeting
that
has
been
hosted
by
the
province
to
which
they
issue,
our
for
which
they
issue
the
invitation.
So
it's
their
meeting
and
they're
issuing
the
invitations
to
those
who
have
have
interest
and
purview
over
the
issue.
H
Through
the
chair,
the
province
actually
is
up
from
what
we
understand
with
the
other
jurisdictions
that
have
already
had
such
meetings.
There
is
a
high-level
agenda
that
provides
an
opportunity.
They
have
a
presentation,
that's
my
understanding
of
the
way
these
meetings
have
gone.
The
province
provides
a
presentation
and
then
they
open
they
have
a
fairly.
It
sounds
like
a
fairly
open
dialogue.
People
may
ask
invitees.
Participants
can
ask
questions
of
them.
Provide
insights,
make
their
comments
in
respect
of
the
consultation
paper,
the
presentation
or
any
other
issues
related
to
public
health.
J
To
clarify
the
survey:
is
it
open
to
the
public
through
the
chair?
Yes,
and
to
your
knowledge,
has
the
has
the
Ministry
committed
to
making
public
the
results
of
the
consultation
in
the
survey?
To
my
knowledge,
no
and
in
terms
of
the
trajectory
of
this
project
and
the
timing,
has
the
ministry
declared
any
intentions
around
when
they
expect
it
to
be
finished
so.
H
Through
the
chair,
my
understanding
is
that
the
survey
itself
that
public
survey
that's
available
online
is
open
until
February,
the
10th
I,
don't
know
when
their
final
consultation,
in-person
consultation
with
jurisdictions
is
I,
do
know
that
ours
is,
is
currently
they're
targeting
February
the
10th,
and
there
may
be
dates
after
that.
But
beyond
that,
we
really
don't
know
what
the
wrap-up
looks
like.
It
sounds
as
I
have
indicated,
based
on
the
conversation
that
we've
had
with
other
jurisdictions,
who've
had
their
in-person
consultation.
It
sounds
like
the
process
that
the
province
is
undertaking
is
rather
fluid.
K
What's
what
is
generated
out
of
that
and
I
guess
the
step
that
I
feel
is
missing
and
I'm,
trying
to
figure
out
how
we
get
that
step
is
an
opportunity
for
some
members
of
the
Board
of
Health
or
any.
All
of
us
are
some
of
us
in
small
groups
to
sit
with
some
public
health
staff,
or
at
least
be
given
a
piece
of
paper
that
says
this
is
what
public
health
staff
have
raised.
These
are
the
kinds
of
issues
and
give
us
a
chance
to
engage
in
it
and
I'm
wondering.
K
Is
there
any
possibility
of
you
know,
members
of
the
board
and
members
and
Toronto
Public
Health
staff
to
have
a
bit
of
a
conversation
before
we
provide
that
input
on
the
10th
I
realize
that's
really
fast,
but
even
informally
there
may.
There
must
be
something
so
I'm
wondering.
Is
this
something
that
you
can
conceivably
find
an
approach
for
so.
H
Through
the
chair,
I
think
this
presentation
was
meant
to
be
the
beginning
of
that
conversation,
recognizing
that
it
is
January
13th,
and
this
I
admit,
is
a
very,
very
rapid
process
right.
The
the
province
came
out
with
their
paper
towards
the
end
of
November
by
then,
as
you
know,
we're
starting
to
move
into
holiday
season,
and
so
you
know
that
the
we
have
some
timing
challenges
for
sure,
but
this
was
meant
to
be
the
opening
salvo
to
a
conversation.
What
I'm
going
to
suggest
is
what
we
were
happy
to
put
together.
H
We
are
put
pulling
together
the
information
again.
The
staff
session
was
held
also
not
that
long
ago,
as
it
turns
out.
So
it
does
take
some
time
to
pull
the
information
together
and
to
summarize
it
into
something
that
is
actually
be.
You
know
that
that
would
be
useful
for
you
as
as
a
board,
to
engage
with
so
very
happy
to
do
that
and
to
start
some
confident
to
figure
out
what
makes
the
most
sense.
We
know
how
very
busy
your
schedules
are.
H
How
do
we
set
this
up
so
that
you're
able
to
engage
in
this
meaningfully
very
happy
to
take
that
away
and
then
communicate
with
members
of
the
board
offline
to
figure
out
what
makes
sense,
because
you
all
have
very,
very
busy
schedules.
We
know
we've
been
trying
to
arrange
a
few
other
sessions
that
have
have
presented
some
challenges.
Just.
K
H
Course
so
through
the
chair
we
just
have
to
be
mindful
of
you,
know
the
appropriateness
and
the
rules
of
how
the
board
should
work,
what
constitutes
a
board
meeting
and
what
scene
is
appropriate
and
no
but
happy
to.
We
will
take
that
offline.
There
are
certain,
as
you
know,
certain
standards
that
we
have
to
oppose
and.
C
H
C
C
Today,
so
at
our
last
meeting
in
December,
we
requested
this
report,
which
is
in
front
of
us,
and
we've
requested
this
board
a
formal
meeting
with
the
special
advisor
and
the
province.
So
you've
mentioned
February
10th
is
that
confirmed.
Have
they
said
that
they
are
going
to
meet
with
the
Board
of
Health
On,
February
10,
so.
H
I
have
had
that
verbally,
they
are
looking
for
a
contact.
I
just
received
notification
on
Friday
that
they're
looking
for
a
contact.
I
now
have
that
contact
for
them
to
start
to
make
arrangements,
and
what
I
have
in
writing
is
February,
10th,
okay,
they
said
they
would
like
to
start
making
arrangements.
Okay,.
C
The
substance
of
what
is
being
discussed
here
so
the
discussion
paper
and
and
I've
struggled
in
part.
Having
read
the
discussion
paper
read
the
report
hear
from
public
health
staff
is
and
yourself
to
understand
what
what
are?
What
are
the
risks?
I
mean
what
what
is
going
well,
that
is
not
reflected
in
the
report
that
we
need
to
ensure
is,
is
carried
forward
and
where
are
the
risks,
as
evidenced
in
their
early
discussion
paper,
so.
H
That
is
a
that's
a
hefty
question
and
I
I.
Don't
know
that
I
can
answer
it
within
the
time
that
you
have,
but
suffice
it
to
say
that
there
are
a
number
of
issues
that
we
see
within
the
context
of
the
report.
The
the
consultation
paper
and
one
of
the
challenges
that
emanates
that
a
gale
made
in
the
presentation
is
that
public
health
is
is
actually
is
a.
It
is
a
system
in
and
of
itself,
and
it
is
separate
but
related
to
health
care
and
other
social
service
partners.
H
H
There
are
municipal
partners,
there
are
community
agencies
that
all
contribute
and-
and
the
concern
that
we
have,
if
I
had
to
put
it
in
an
overarching
overriding
concern,
is
that
the
the
current
paper
does
not
view
public
health
appropriately
as
a
true
system
of
which
local
public
health
has
a
key
role,
but
not
the
only
role.
Yes,.
C
When
I've
read
the
discussion
paper
and
our
report,
local
governance,
I
did
not
see
within
the
discussion
paper
and
the
importance
of
a
locally
responsive
and
organized
body.
I
didn't
see
the
principle
of
stable
and
predictable
funding
reference
diet,
others
on
the
board,
have
talked
about
the
role
of
prevention
and
health
promotion,
the
role
of
health
equity,
those
core
tenants
as
I
see
them
of
an
effective
public
health
system.
C
C
H
You,
mr.
chair,
if
you
look
at
the
presentation
and
actually
when
you
look
at
our
previous
reports,
we
have
the
board
actually
has
established
responses
and
has
positions
that
they've
adopted
in
respect
of
public
health,
stable
and
predictable
funding.
If
you
look
on
your
slides,
it's
on
slide
15.
It's
actually
explicitly
mentioned
there
and
we
actually
have
mentioned
that
several
times
in
the
past.
H
C
L
You
very
much
mr.
chair,
so
when
I
saw
the
report
from
the
medical
officer
fellows
regard
this
item,
I
thought
the
recommendation
was
of
what
was
very
passive,
because
what
I
saw
mr.
chair
uses
circulate
the
demotion
amendment
because
we
got
to
communicate
to
the
ministry
to
this
province.
The
governmental
inter
government,
because,
if
they're
going
to
modernize
public
health
moving
forward,
whatever
they're
gonna
modernize
could
affect
us
to
the
core.
Well,
there
is
funding
whether
it
is
the
standards
or
the
stuff
that
we
believe
in,
and
you
alluded
to
some
of
them.
Mr.
L
chair,
as
was
others
dealing
with
the
whole
issue
of
equity,
the
issue
of
stable
fundings.
What
have
you
so
I?
Don't
know
what
the
final
outcome
of
our
discussion
will
be
in
terms
of
recommendation
of
this
piece
of
consultation.
But
we
really
need
to
make
sure
that
we
verbalize
both
in
writing
and
those
who
are
attending
the
February
10th
meeting
to
indicate
what
our
guiding
principle
for
this
board
that
we
have
been
championed
now
for
over
a
year
or
for
many
many
years
at
the
Toronto
Public
Health.
L
Because
what
I'm
concerned
about
is
that,
if
we
don't
proactively
and
I,
think
director
purtz
indicated
earlier
that
we've
got
to
make
sure
our
concerns
advocacy
work
for
decades
on
public
health
doesn't
get
diminished
as
they
modernized.
What
is
public
health
for
the
province,
because
at
the
end
of
the
day,
this
is
going
to
be
stuck
with
us
in
terms
of
future
funding.
But,
more
importantly,
what
is
the
role
for
staff,
but
also
for
our
mandate
as
a
board?
L
K
Thank
you
I'm
profoundly
concerned
about
this
moment
for
Public
Health.
Yes,
we
did
survive
last
year,
a
budget
attack
but
I'm.
Looking
at
this
I'm
just
terrified
to
begin
with
the
word.
Modernization
I
haven't
a
clue
what
it
means
it
can
mean
anything,
there's
a
nothing
in
I've.
Anything
I've,
seen
communicated
from
the
province
of
Ontario
tells
me
what
is
different
between
the
moment
we're
in
today
and
the
moment
we
will
be
in
10
years
from
now
and
how
modernizing
gets
us
from
one
or
the
other.
K
It's
it's
an
essentially
meaningless
discourse
and
when
you've
got
something
meaningless
that
you're
being
asked
to
participate
in.
That
means
you
have
no
idea
what
the
real
outcomes
that
are
imagined
by
the
province
might
be,
and
that's
the
terrifying
thing
one
of
the
things
that
I
think
is
most
important
about
public
health.
Is
that,
unlike
the
rest
of
the
medical
system,
which
is
dealing
with
a
patient
to
to
improve
a
health
outcome
with
a
disease
or
something
some
treatment
or
medicine
that
you
want
to
want
to
do?
K
Is
public
health
talks
about
health
on
a
population
level
and
because
it
talks
about
health
on
a
population
level,
it
automatically
finds
itself
interrogating
questions
of
the
inequities
in
our
society
and
the
health
impacts
of
those
inequities.
Other
words
it's
built
in
that
it
asks
hard
questions
about
how
our
society
is
organized
and
I.
K
Just
want
everyone
just
to
you
know,
make
it
a
bit
of
a
priority
over
the
next
couple
of
weeks
to
jot
down
some
thoughts
to
think
about
how
you
can
communicate
directly
with
the
chair
or
the
medical
officer
of
health
or
find
time
to
meet
in
small
groups.
We
need
to
be
are
able
to
articulate
the
case
for
why
public
health
is
so
important
to
the
broad
social
health
outcomes
and
equity
in
our
city.
J
Thanks
and
just
to
build
on
what
director,
perks
and
director
Wang
said,
I
think
it's
really
important
that
what
we
do
put
forward,
that
we
are
very
deliberate
about
making
it
extremely
public
working
in
the
education
sector.
I've
now
been
through
one
of
this
government's
largest
consultations
in
the
history
of
the
province,
where
the
it's
a
quote,
where
the,
where
the
results
were
still
have
not
been
made
public
I'm,
not
sure
that
they
ever
will.
But
there's
been
several
organizations
who
have
done
polling.
The
feedback
from
the
public
has
been
loud
and
clear.
J
Yet
the
government
refuses
to
to
share
the
results
of
this
consultation,
so
I
would
urge
this
board
and
the
medical
officer
to
be
really
explicit
about
of
making
our
needs,
and
our
concerns.
Public
and
I
would
also
ask
that
you
urge
other
local
public
health
units
to
do
the
same,
because
our
our
community's
really
deserve
to
know
and
the
whole
province
should
know
as
well.
Thank
you.
G
The
timing
seems
very
challenging
the
discourse
around
population.
Health
is
worth
noting
that
Ontario
health
teams
in
the
healthcare
system
integration
has
been
tasked
with
population.
Health
management.
Is
that
the
same
thing
as
population
health
from
a
public
health
perspective
who's
going
to
be
responsible
for
what
I
think
there
are
a
lot
of
questions
there
and
there
I
think
it's
important.
You
know
in
the
history
of
public
health,
modernization
papers
that
have
come
out
over
the
last
20
or
even
30
years.
G
G
Local
accountability,
local
governance,
whether
or
not
that
needs
to
be
identical
with
municipal,
is
something
that
I
think
is
something
that
we
need
to
have
a
conversation
about
as
a
board.
So
I
think
there
are
a
number
of
things,
and
so
I
just
wanted
to
register
my
concern
about
the
time
and
the
opportunity
to
reiterate
the
positive
opportunity
we
have
to
set
forward
this
vision,
because
these
consultations,
these
kinds
of
quote-unquote
modernizations
they
come
and
go.
This
is
one
and
it's
our
opportunity.
G
C
C
Let
me
start,
first
of
all,
just
by
thanking
our
staff
for
bringing
forward
the
presentation
and
in
the
report
in
front
of
us
I
know
in
when
the
discussion
paper
was
released
at
the
end
of
November.
We
made
this
request
in
the
beginning
of
December
and
it's
early
January
welcome
to
the
process,
that's
underway.
C
As
his
director
Mulligan
was
just
saying,
there
have
been
decades
of
discussion
in
this
province
related
to
public
health,
the
organization
and
funding
and
public
health.
Some
of
those
have
been
reactive
in
response
to
a
SARS
or
a
Walkerton.
We
saw
significant
shifts
in
the
funding
framework
and
some
level
of
coordination
around
public
health
Ontario.
C
Some
of
it
has
been
proactive
whether
it
was
the
last
government
proactively
putting
poor
division
around
reorg,
one
that
was
controversial
and
didn't
completely
come
to
fore,
but
it
was
a
proactive
step
or
in
the
case
of
this
province
pro
actively
without
vision,
but
rather
the
sole
vision
being
that
of
cost-cutting
putting
forward
a
proposal
last
April.
So
that
process,
which
was
proposed
last
April,
thankfully,
has
been
somewhat
reversed
and
we're
back
into
a
reset.
C
So
my
concern
going
into
this
is
that
this
from
the
provincial
side,
I'm,
not
convinced
I'm,
not
sure
what
is
driving
this
reor
completely.
When
I
read
the
discussion
paper
I
see
a
lot
of
language
around
coordination,
alignment
of
services,
but
I,
don't
see
discourse
of
health
equities,
population
health
writ
large
and
how
you
best
accomplish
those
objectives
and
I
also
don't
see
a
lot
of
the
principles
that
have
guided
the
effective
delivery
of
public
health
services
and
policy
over
many
years
with
regards
to
stable
funding,
local
governance
deriving
the
process.
C
And
so
as
we
go
forward,
we
made
a
request
in
December
that
there
is
a
direct
engagement
with
this
board
and
I'm
glad
that
that
person
seems
like
it
will
be
happening
on
February
10th
still
to
be
confirmed.
I'm
not
comfortable
as
a
chair
or
even
just
as
a
member
of
this
board,
simply
going
into
a
consultation,
hoping
that
we're
gonna
that
a
good
outcome,
it's
gonna,
come
from.
It
I
think
some
clear
principles
need
to
be
conveyed
and
communicated
in
advance
of
that
meeting,
which
my
amendment
speaks
to
and
communicated.
C
C
Think
director
perks
was
speaking
to
this,
and
so,
while
the
amendment
I've
in
front
of
us
is
to
endorse
similar
principles
and,
on
behalf
of
this
board,
to
convey
those
in
advance
to
the
province
and
with
this
board,
so
that
we
are
more
prepared,
I
think
when
it's
clear
who
is
able
to
attend
on
the
10th
that
the
onus
will
be
on
me
and
I'll.
Ask
for
the
medical
officer
of
Health's
support
so
that
those
who
are
attending
so
that
we
can
convene
to
chat
in
advance,
be
it
to
workshop
or
Viacom
from
I.
C
Just
also
know
that
province-wide
through
our
office,
we
are
liaison
with
other
boards
of
health
and
sectors
who
are
engaged
have
starting
to
have
those
conversations
with
sectors
who
were
engaged
in
April
within
the
food
policy
community
within
the
student
nutrition
community.
And
we
know
that
that
at-rich
needs
to
take
place
and
so
I'll
simply
close
by
saying
aye.
This
is
an
uncertain
moment
in
public
health
in
this
province.
C
C
Okay,
any
other
speakers,
okay,
seeing
none,
then
we
have
an
amendment
in
front
of
us
all
those
in
favor
opposed
if
any
that
carries
as
amended
nope
just
that.
Okay.
Thank
you
very
much
and
thank
you
to
to
Eileen
you
and
your
team.
We
will
now
move
on
to
our
next
item,
which
is
item
HL,
13.7
mobile,
dental
clinic
three-month
pilot
of
service
delivery
model.
C
M
B
M
B
M
Well,
we
would
have
our
we
currently
do.
Have
our
street
outreach
worker
working
in
the
program,
the
stopgap
measure
would
be
to
have
the
street
average
worker
plus
a
clinical
staff
member,
attend
the
agency
and
provide
the
consultation
and
their
pre
treatment
services
done
at
the
local
level,
and
when
they
do
require
the
treatment
services,
they
would
be
shuttled
driven
provided
service
at
the
clinical
level
aid.
One
of
our
24
clinics.
H
Sorry
through
the
chair,
I
think
the
issue
is:
is
that
the
fact
that
the
mobile
dental
clinic
requires
this
significant
investment
only
came
to
our
attention
relatively
late
in
the
year.
So
in
fact,
it
is
not
operable
right
now.
So
this
is
an
opportunity
for
us
to
continue
to
provide
services
to
a
population
that
really
needs
this
surface
and
is
quite
vulnerable
and
as
well
to
provide
service
to
a
greater
number
of
clients.
H
The
model
that's
being
proposed
should
allow
us
to
provide,
or
at
least
give
us
the
opportunity
to
provide
service
to
a
greater
number
of
clients
for
the
number
of
hours
of
operation
and
at
the
same
time,
that
gives
us
the
opportunity
to
explore,
because
it
does
take
time
to
put
things
through
to
have
a
sense
as
to
how
much
will
it
cost
to
either
repair
the
mobile
dental
clinic
or
acquire
a
new
one.
Depending
on
what
the
particular
you
know
what
the
assessment
of
the
vehicle
provides
for
us.
H
We
have
to
do
some
investigation
in
order
to
invest
further,
and
there
is
that
will
have
to
be
done,
because,
given
the
timing,
it
could
not
be
inserted
into
the
capital
budget.
We
actually
have
to
make
the
adjustment
to
our
capital
budget
within
the
first
quarter,
so
that
all
does
take,
unfortunately,
a
little
bit
of
time,
and
what
we're
trying
to
do
here
is
preserve
service.
In
the
interim.
B
And
under
these
the
the
prior
model,
the
street
outreach
worker
we're
actually
drew,
was
the
they
actually
drove
the
mobile
dental
clinic.
And
if
we
were
to
get
this
program
up
and
running,
would
that
still
be
the
best
use
of
the
street
outreach
workers?
Time?
Because,
when
you're
driving
the
bus
when
you're
driving
when
you're
iving
the
clinic
you're
not
actually
actually
working
face-to-face
with
with
the
population
that
you're
trying
to
serve
you're,
just
basically
a
driver
right.
M
I
mean
the
best.
The
best
use
of
the
street
art
workers
time
is
to
do
outreach
in
the
individual
okay
in
the
in
the
community.
However,
we've
tried
to
explore
many
models
about
driving
the
bus
to
the
specific
location
we'll
have
to
explore
further,
but
it
was
a
challenge
to
get
just
a
driver
to
drive
the
bus
for
an
hour
to
a
location
so.
B
Just
to
understand
so
the
the
the
revised
service
is
to
actually
do
the
outreach
in
the
communities
and
the
agencies
where
people
are
already
receiving
other
services
and
then
you'll
be
chauffeuring
them
transporting
them
to
the
other
clinics
that
are
a
brick-and-mortar
clinics
to
get
their
assessments
to
get
the
the
the
dental
treatments
that
they
need.
That's.
B
I
L
You
mr.
chair,
so
I
receive
a
communication
from
Vicky
Rennie
about
this
particular
report.
Mr.
chair,
through
you
to
the
medical
office
of
Health,
so
this
particular
deputy
asks
that
what
does
she
say
here?
She
said:
she's,
encouraging
Toronto
Public
Health
to
reach
out
both
the
mobile
dentures
and
dental
hygienists
to
be
included
in
this
project.
So
through
you
to
the
medical
health.
Is
that
being
considered
as
this
alternative
dental
model?
That's
being
suggested.
L
What
it
said
it
was
a
handle
just
given
to
the
board
members
that
the
that
this
particular
to
ask
that
she's
she's
encouraging
the
Toronto
Public
Health
to
reach
out,
to
quote
both
the
mobile
dentures
and
dental
hygienists,
to
be
included
in
this
pilot
project.
So
I
just
want
to
know
is
this
being
considered
for
this
three
months
pilot
project,
so.
H
Through
the
chair,
that
option
is
not
currently
being
considered
for
part
of
this
pilot.
I
would
suggest,
however,
that
in
part
and
parcel
of
our
regular,
how
do
we
continuously
improve
our
service
if
there
is
benefit
to
incorporating
different
models
of
care?
I
think
we
should
always
be
open
and
exploring
what
are
the
different
models
of
care,
and
does
it
make
sense
within
the
context
of
our
working
environment
and
to
serve
our
clients
so
that
that
particular
we
just
got
the
communications
as
you
did
today,
will
certainly
take
it
back
and
determine
I.
H
L
Last
question:
youth
chair
through
the
chair
to
the
Medical
Service,
when
the
three
months
pilot
report
coming
back
to
the
board.
Can
we
get
a
idea
with
a
new
funding
from
the
province
for
the
dental
program?
How
would
that
help,
especially
those
vulnerable
residents
that
we
have
is
supposed
to
be
improving
their
dental
care
and,
more
importantly,
how
do
we
ensure
that
this
is
a
citywide
initiative,
because
oftentimes
I
raise
that
concerns
when
the
mobile
clinic
was
out
in
Scarborough
and
we
didn't
really
know
about,
and
then
we
stay
in
the
middle
a
parking
lot.
L
H
Through
the
chair,
the
Ontario
seniors,
dental
care
program
actually
has
some
very
specific
requirements
of
it
and
that
actually
is
services
delivered
to
eligible
seniors
throughout
the
province
and
it's
within
the
context
and
I'm
return
to
staff,
public
health
clinics
yeah,
any
public
health
clinic
through
Aboriginal
health
access,
centers
and
through
CHCs.
You.
H
Community
health
centers
excuse
me,
so
there
are
some
very
specific
requirements
for
that
funding.
That
actually
is
quite
separate
from
this.
That's
not
to
say
that
there
aren't
vulnerable
and
eligible
seniors
who
might
actually
be
taking
advantage
and
capitalizing
on
the
service
that
we
provide,
or
that
we
have
traditionally
provided
through
the
mobile
dental
clinics.
H
I
can
assure
you
that
the
report
that
we
bring
back
will
give
you
a
sense
as
to
what
we
determined
through
the
pilot
and
we'll
offer
some
suggestions
for
you
to
consider
in
respect
of
how
best
to
provide
good
quality
dental
service
to
those
who
need
and
to
those
who
would
benefit
most
from
from
the
model
that
has
traditionally
been
delivered.
Thus
far.
H
C
You
any
other
questions:
okay,
seeing
none
to
speak.
I'll,
put
myself
on
the
list.
I
have
an
amendment
if
it
can
be
moved
and
it's
specifically
to
request
the
MOH
to
report
at
the
end
of
the
pilot
on
the
interim
delivery
model.
The
alternate
delivery
model
specifically
on
two
fronts:
one
is
a
review
of
the
performance
and
the
second
is
any
information
on
additional
funding
required
to
sustain
it.
So
let
me
tell
you
what,
as
I
see
the
goal
and
the
concern
I
have.
The
goal
obviously,
is
anytime.
C
That's
a
good
thing:
that's
what
we're
trying
to
do
where
the
concern
I
would
have
is
the
vehicle
breaks
down.
Therefore,
we
stopped
funding
the
vehicle
and
we
get
worse
service
that
that
would
be
a
bad
thing
and
so
I
want
to
thank
our
staff
too
for
moving
quickly
when
the
vehicle
broke
down
to
come
up
with
a
model
to
ensure
the
continuity
of
this
service.
That's
good!
If
we
can
do
it
better,
that's
great
but
I
want
to
make
sure
because
I
know
the
report
mentioned
that
we're
going
to
evaluate
it.
C
I
would
like
to
ensure
that
we
at
the
end
of
this
period,
I'll
report
back
to
the
board
with
the
consideration
so
that
we
can
evaluate.
Are
we
enhancing
the
level
or
are
we
seeing
a
reduction
in
service
quality?
Any
other
speakers?
Okay,
all
those
in
favor
of
the
amendment
and
that's
mended
any
opposed
seeing
none!
Okay!
C
Moving
on
to
our
final
item,
HL
13.8
Subway
health
impacts
study.
Do
we
have?
Is
there
we
don't
have
a
presentation
on
this?
No,
we
don't
okay.
So
we
have
speakers.
There
is
a
speaker
listed
Hamish,
Wilson
Hamish.
We
see
what
other
committees
we
don't
see
you
as
much
here
down
at
the
Board
of
Health.
Welcome.
F
Well,
I,
the
the
real
work
is
for
cleaning
up
our
mobility
and
changing
it
tends
to
be
at
the
other
committees,
not
so
much
here,
even
though
you
do
a
lot
of
good
work
and
it's
been
really
hectic
for
you
with
our
Doug
tater
blowing
or
trying
to
blow
up
many
things
and
he's
not
getting
away
with
it.
Thank
you
for
pushing
back
decades
back
I
got
interested
in
air
pollution
issues
through
acid
rain,
which
also
we
couldn't
just
point
fingers
at
the
u.s..
F
We
had
to
have
clean
hands
and
look
at
what
we're
creating
within
our
own
city
and
that
led
to
mobility
issues
and
cars.
I
did
realize
from
that
that
there's
an
awful
lot
of
pollution
around
that
we
don't
actually
see
you
can
almost
see
the
pollution.
Sometimes,
if
you
have
a
strong
light
source,
that's
kind
of
not
in
your
field
of
vision.
F
You
can
see
the
haze
so
if
you're,
seeing
that
sort
of
haze
and
and
a
beam
of
light
in
a
subway
tunnel,
now
the
if
it's
mostly
fine
particulate,
there's,
definitely
a
problem
or
a
set
of
problems.
So
I
really
hope
that
we'll
take
it
quite
seriously,
I'm,
not
sure
it's
not
so
clear
from
the
the
the
summer
report
where
the
pollution
is
coming
from.
F
However,
once
it
is,
it
from
braking
is
that
the
major
concern
is
that
the
seepage
in
of
contaminated
air
from
street
level
in
into
the
subway
tunnels,
is
it
from
maintenance
and
welding
and
activities,
is
a
recirculation
of
the
you
know.
As
a
train
comes
in
to
a
station,
does
it
push
disturb
the
dust?
It's
not
entirely
clear
from
from
the
the
the
the
the
the
the
intermediate
level
report
where
exactly
the
the
problem
is
from
another
issue
that
I
don't
see
that
it.
F
You
know
I
gain
not
in
the
summary
and
and
I
should
have
explored
further.
Is
it
are
there
any
variations
by
season
by
time
of
day?
Is
it
concentrated
in
the
older
parts
of
the
system
lying?
To
is
worse?
It
is
an
older
part
versus
an
older
set
of
a
part
of
the
system
versus
line
to
which
is
order
line,
one
which
is
very
extended
now
with
new
stations.
So
is
it
concentrated
in
the
old
parts
of
the
system
and
I
think
your
options
to
fix
it
are
a
little
weak
as
well.
F
Unfortunately,
one
option
that
might
actually
help
is
to
try
paint
spray
painting
to
see
if
that
actually
helps
to
seal
in
some
of
it,
especially
as
you
approach
stations.
Perhaps
it
could
be
wrong
at
least
tray
give
it
a
try
see
if
it
makes
a
difference
and
one
of
the
other
things
that
I
think
is
really
important.
There's
another
wonderful
mobility
option,
instead
of
just
saying
to
people
hate,
keep
on
taking
the
subway
and
paying
a
lot
for
it.
Why
not
really
encourage
better
biking
along
the
bluer
and
Danforth?
F
That
is
part
or
should
be
part
of
the
the
public
health
solution
proposal
to
alleviate
the
air
pollution,
because
it's
not
just
about
the
safety
of
the
the
passenger.
It's
easy
passengers
within
the
within
the
system.
Biking
is
much
much
better
for
us
all
all
told,
and
we
should
know
by
now
that
we
actually
have
a
lot
of
pent-up.
Oh,
this
comes
up.
Yes,
we
have
a
lot
of
interest
in
seeing
cycling
on
the
Danforth
by
a
crash.
F
That's
being
missed,
it
seems,
have
I
got
this
for
the
right
way,
somehow
from
Sherbourne
over
to
church.
That
little
bit
is
was
in
the
2001
bike
plan,
the
remnant
of
stage
1
from
the
1992
study.
That's
still
not
good
enough
and
I
think
it's
missed
in
all
the
studying.
That's
going
on.
So
please,
please,
please.
It
would
be
really
helpful
to
have
if
you're
going
to
make
a
motion
to
support
the
bike
way.
Try
and
get
something
done
this
this
year
doesn't
have
to
be
a
bike.
F
Lane
right
away,
I'd
be
happy
with
the
sharrows,
because
it
it
would
be
something
there's
a
condo
construction
I'm
almost
out
of
time.
Another
thing,
that'd
be
really
helpful,
is
to
encourage
the
city
to
actually
do
better
job
on
the
winter
maintenance.
This
is
from
last
year.
It's
a
pinch
point.
It's
a
highway
on
Bloor
East
at
the
top
of
Parliament.
The
bike
lane
becomes
a
bike
line,
often
and
that's
not
OK.
Unfortunately,
we
have
less
confidence
in
the
in
the
repaving
as
well
on
for
fresh
repaving,
which
is
wonderful.
F
There
was
our
bike
lake
there
at
that
same
point,
just
around
the
curve
prior
to
painting
and
then
recently
we
just
had
repaving,
but
it's
still
not
okay.
You
know
it's
a
pinch
point.
It's
really
so
in
order
to
really
have
that
mobility
option
made
safe,
which
is
something
that
you
should
do
for
to
respect
all
the
the
transit
users,
because
this
is
sort
of
how
we're
at
there's
a
pedestrian
there's
the
bike,
that's
your
subway
you're,
your
transit
and
there's
the
private
car.
Thank
you.
F
F
C
You
very
much
Seamus.
Are
there
any
other
members
of
the
public
here
who
wish
to
speak
on
this
item?
Okay,
seeing
none
we're
gonna,
move
it
into
committee,
then
we'll
start
with
questions
of
staff
and
I'd
note
for
members
of
the
board.
We
have
a
report
here
from
the
medical
officer
of
Health,
but
we
do
have
staff
here
from
the
TTC.
If
there
are
questions
of
them
as
well.
L
You
mr.
chair,
so
I
threw
you
to
the
medical
health
with
regard
to
this
report.
It
focused
primarily
on
the
health
benefits
or
the
issues
affecting
the
health
of
the
passenger.
There's
no
references
that
I
read
dealing
with
the
workers
because
we're
just
visiting
the
subway
yet
are
we
not
concern
about
the
employees
of
the
TTC
who's
there
longer
than
we
will
be
on
the
subway.
H
L
C
Thank
you
so
I
have
a
couple.
Questions
I
mean
I.
Think
members
of
this
can
the
board
have
probably
had
time
to
drill
down
into
this,
it's
being
very
prominent
for
the
last
little
while
as
it
relates
to
PM
2.5.
The
fine
particular
matter
am
I
correct
in
my
understanding
that
there
are
no
guidelines
at
the
federal
level
or
at
any
other
level
of
to
what
the
level
of
PM
2.5
should
be
for
passengers.
In
short,.
C
So
I
know
in
doing
the
independent
health
assessment
you
have
assessed
that
there
is
no
immediate
risk.
In
fact,
I've
seen
this,
that
the
record
there,
the
advice
is
that
taking
the
subway
is
good
for
your
health,
but
could
be
made
even
better
with
mitigation.
But
why
not?
Why
no
recommendation
or
request
for
the
federal
government
or
others
to
create
guidelines
on
PM
2.5?
So
it's
not
up
to
us
on
our
so.
H
Through
you,
mr.
chair,
clearly
would
not
be
up
to
us
on
our
own
and
I.
Think
it's
reasonable
to
ask
for
those
guidelines
to
be
created
or
standards.
I
expect
that
it
might
be
challenging
for
some
of
our
federal
partners
to
do
that.
There
is
no.
We
know
that
PM
2.5
is
one
of
those
exposures.
If
you
will
that
really
doesn't
have
a
threshold
er,
no,
no
one
threshold,
but
I
expect
that
our
counterparts
would
have
some
challenge
and
putting
those
together.
I.
H
C
H
Through
you,
mr.
chair,
no,
we
know
of
no
such
guidelines
that
have
been
established.
We
know
that
there
is
you
know,
interest
and
people
are
looking
into
this.
This
is
a
relatively
new
challenge
and
other
subway
systems
around
the
world
are
also
trying
to.
You
know,
manage
and
figure
their
way
through
this
okay.
C
H
In
short,
through
you,
mr.
chair,
when
we
did
a
health
impact
assessment
and
the
overall
conclusion
of
the
health
impact
assessment
is
that
taking
the
subway
and
encouraging
subway
use
is
something
that
we
should
be
doing,
both
as
a
board
of
health
as
a
public
health
department,
and
we
should
be
encouraging
people
throughout
the
city
for
a
wide
variety
of
reasons.
There
are
a
number
of
positive
health
benefits
and
for
articulated
in
the
report,
for.
C
H
The
health
impact
assessment
concluded
that
no,
we
should
be
encouraging
people
to
continue
to
ride
this
out
way.
That
being
said,
the
levels
of
PM
2.5,
as
recorded
in
the
study,
suggests
that
there
is
benefit
to
mitigation
and
that,
by
engaging
in
those
mitigation
actions,
we
would
enhance
the
health
benefits
of
riding
the
subway
and
using
public
transit.
Okay.
C
J
Thanks
chair
I,
thank
you
for
this
report.
I
noticed
on
page
7,
there's
a
section
entitled
mitigation
is
especially
important
for
line
2,
and
it
says
that
the
PM
2.5
exposure
level
during
weekday
rush
hours
for
line
1
is
85.
I,
actually
don't
know
how
to
say
that
measurement
micro
micrograms
and
online
it's
a
hundred
and
eighty-three.
So
in
in
our
findings.
There
are
the
findings
of
Toronto
Public
Health.
Are
there
factors
that
we
determined
that
are
contributing
to
100
point
difference
between
the
two
lines
so.
H
Through
the
chair,
the
factors
have,
you
are
not
really
entirely
clear
and
we
know
that
that's
not
only
the
case
for
Toronto,
but
it
seems
to
be
the
case
as
well,
based
on
our
assessment
for
the
other
jurisdictions
as
well.
So
that's
why
there's
a
real
opportunity
and
for
the
TTC
to
engage
in
this
and
to
conduct
further
study
in
partnership
with
the
with
Health
Canada
and
with
the
industry
and
other
researchers.
That's
what
was
referred
to
in
the
report.
Ok,.
G
Thank
you
for
this
piece
of
work.
I
have
a
quick
question
about
risk
communication,
which
I
think
is
part
of
the
underlying
unspoken
work
of
this
that
you
know
that.
So,
ok,
let
me
just
get
right
to
it
under
no
under
2d
monitoring
levels
of
subway,
subway,
PM,
2.5
and
evaluating.
It
is
the
intention
that,
given
that
these
would
be
monitored
that
the
monitoring
results
would
be
made
public.
H
So
through
the
chair,
the
monitoring
that
has
been
done
to
date
has
been
done
through
in
partnership
between
the
TTC
and
Health
Canada,
and
some
other
research
partners
that
are
brought
on
board.
Our
understanding
is
is
that
that
partnership
and
collaboration
is
expected
to
continue
and
to
date
most
of
the
results
have
been
coming
out
through
publication.
So
further
public
reporting
from
Health
Canada
would
be
a
question
that
we
would
have
to
direct
to
Health
Canada,
okay,.
H
The
chair,
I
think,
there's
always
been
a
role
for
Toronto,
Public,
Health
and
respect
of
contextualizing
results
of
studies,
whether
it's
with
respect
to
air
quality
or
any
other
exposure
in
the
city,
so
that
people
can
understand
what
the
circumstances
are
here.
That
being
said,
the
broader
about
you
monitoring
and
the
studies
and
the
collaboration
are
actually
occurring
between
the
TTC
and
there
are
other
research
partners
which
include
Health
Canada.
So.
G
H
The
thing
is
is
that
we
know
that
if
we
do
not
encourage
greater
use
of
public
transit
and
other
forms
of
active
transportation
for
the
reasons
articulated
in
the
report,
actually
there
is
risk
associated
with
a
broader
environment
and
actually
degradation
are
degrading,
our
external
environment
even
further.
So
there
is
an
opportunity.
This
is
still
an
emerging
area
of
research.
We
are
just
starting
to
understand:
PM
2.5
exposures
within
the
subway
that
is
not
unique
to
Toronto,
that
is
in
all
other
subway
systems
that
are
similar
to
that
which
we
see
in
Toronto.
H
So
we
now
know
something
new
that
we
didn't
know
before
relatively
recently,
and
we
have
I
think
a
responsibility
and
an
obligation
to
work
with
our
partners
to
ensure
that
we
address
that.
How
it's
best
addressed
I,
think,
is
still
very
much
a
question
and
is
an
area
of
further
study
and
conversation
within
subway
service
providers.
Amongst
the
research
community
and
I
would
say,
amongst
health
authorities
with
large.
B
B
So,
with
respect
to
I
think
the
hamish
is
still
here,
he
asked
some
questions
which
I,
don't
believe,
are
answered
in
the
report,
but
what
is
causing
the
increase
of
the
of
the
density
of
particulars
in
the
subway
tunnels
and
platforms?
Is
that
the
brakes?
Is
it
the
the
lack
of
external
air
intake
circulation?
H
Through
the
chair,
it
probably
is
better
answered
by
our
colleagues
at
the
subway,
but
I
would
tell
you
this.
My
understanding
is
that
that
has
yet
to
be
determined.
Those
are
all
reasonable
hypotheses,
but
the
definitive
answer
has
yet
to
be
determined
again.
This
is
a
relatively
new
understanding
that
we're
coming
to
and
when
I
say
we
I
don't
mean
just
Toronto
I'm
talking
about
subway
system
operators
writ
large
operators
of
similar
subway
systems.
Let
me
be
clear
about
that.
J
B
Because
the
report-
and
thank
you,
that's
very
that's
somewhat
helpful,
but
but
because
the
report
speaks
to
the
fact
that
this
is
a
somewhat
of
an
acceptable
level,
but
we
should
try
to
reduce
the
the
the
density
of
this
particular
matter
in
the
subway.
It's
also
speaks
to
the
fact
that
there
there
could
be
effects
for
those
who
have
respiratory,
chronic
respiratory
challenges,
I'm
a
sufferer
of
asthma,
so
oftentimes.
When
people
tell
me
that
it's
that
the
environment
is
accessible
to
someone
who's
actually
living
with
respiratory
challenge,
it's
actually
not
very
acceptable.
B
H
That
being
said,
for
individuals
who
have
very
specific
medical
concerns
and
medical
conditions,
whether
we're
talking
about
heart
or
lung
conditions,
the
advice
that
we've
provided
is
that,
if
you
have
those
concerns
and
are
having,
you
know
particular
challenges
or
have
questions
in
respect
of
what's
best
for
you
as
an
individual,
that's
done.
We
feel
best
in
the
context
of
a
conversation
with
your
health
care
provider,
who's
knowledgeable
around
your
specific
medical
conditions
and
what
triggers
worsening
or
exacerbation
of
your
medical
condition
that
that
cannot
be
done
in
a
general
level.
Thank.
B
H
Yeah
sorry
through
the
chair,
that
may
be
the
case,
but
in
fact,
in
medical
practice,
we
know
that
there
are
a
number
of
conditions
so,
for
example,
on
those
really
hot
smoggy
days,
we
know
that
medical
providers
will
often
tell
their
patients
who
suffer
from
more
extreme
forms
of
heart
or
lung
disease
to
be
mindful
around,
perhaps
not
engaging
in
vigorous
activity
or
exercise
outside.
So
those
kinds
of
individual
sort
of
individually
focused
pieces
of
advice
are
our
best
offered.
In
that
context
you
know
or
increase
puffer
use,
or
what
have
you?
J
C
You,
okay,
that
amendment
has
been
placed
and
anybody
else
to
speak.
All
right,
I'll
make
a
few
comments
if
I
could
begin
first
by
placing
an
amendment
that
the
forging
afford
encourage
Health
Canada
to
continue
its
research
on
air
quality
issues
in
the
TTC
and
to
establish
health
based
guidelines
for
PM
2.5
in
Subway's.
C
So
let
me
begin,
first
of
all
by
thanking
our
staff.
A
request
was
made
in
2017
for
Toronto
Public
Health
to
assess
the
air
quality
for
passengers
within
our
subway
system
and
an
exceptionally
large
amount
of
good
work
has
been
done
and
hard
work
to
get
to
this
point,
and
it's
hugely
important,
as
we've
seen
in
the
report
and
heard
from
dr.
Davila.
This
is
the
issue
of
air
quality
and
air
quality
within
Subway's
is
an
emerging
issue
around
the
world
in
subway
systems
and
and
I.
C
Think,
if
there's
a
message
here,
the
message
for
residents
is
certainly
that
our
Subway's
are
indeed
safe,
but
with
further
mitigation
there
can
be
further
health
benefits.
So,
that's
to
me
the
resident
message
to
residents
I
think
the
message
to
the
TTC
and
we've
heard
them
welcome
this
report
and
and
express
their
thanks
not
only
to
Toronto
Public
Health
for
the
report,
but
also
their
commitment
to
conduct
mitigation.
I.
C
Think
if
there's
an
S
into
the
TTC,
it
should
be
to
aspire
to
be
a
world
leader
when
it
comes
to
air
quality,
don't
be
satisfied
with
a
pass
from
the
medical
officer
of
Health
use.
This
is
an
opportunity
in
partnership
to
further
improve
the
quality
and
the
air
quality
and
I.
Think
if
there's
a
message
to
the
federal
government
in
health,
canada
in
particular
in
particular,
it's
not
only
to
continue
that
research,
but
to
establish
health
based
guidelines
so
that
you
don't
have
an
ad
hoc
situation
with
different
jurisdictions.
C
Looking
at
this
issue
differently
and
coming
up
with
their
own
conclusions,
and
so
in
conclusion,
this
is
not
this.
This
report
here
is
going
to
City
Council.
It
will
also
be
at
the
TTC
board
and
I
know.
Director
McKelvey
here
is,
is
on
the
TTC
board,
as
well
as
one
of
the
commissioners,
and
so
this
is
not
the
end
of
this
by
any
stretch,
but
also
I
think
it
reflects
and
reinforces
the
role
of
Toronto
Public
Health
in
this
city,
in
that
we
are
more
than
an
evaluator.
We're
not
dr.
C
Davila
is
not
an
accountability
officer
who's
going
to
come
over
and
tell
you
how
you're
doing
rather
we're
a
partner
in
this
and
we're
a
partner
in
not
only
helping
to
identify
and
assess
potential
health
impacts,
but
also
to
improve
them,
and-
and
this
is
just
as
the
TTC
has
warmly
embraced,
this
work
in
this
report.
This
is
a
signal
and
an
open
invitation
from
us
to
the
TTC
to
continue
work
in
collaboration
to
further
mitigate
and
improve
the
health,
and
with
that,
are
there
any
other
speakers?
Okay,
seeing
none.
We
have
two
amendments.