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From YouTube: Board of Health - July 8, 2019
Description
Board of Health, meeting 8, July 8, 2019
Agenda and background materials:
http://app.toronto.ca/tmmis/decisionBodyProfile.do?function=doPrepare&meetingId=15397
Meeting Navigation:
0:07:01 - Call to order
Agenda Items:
0:10:18 - HL8.1 - Toronto Urban Health Fund Indigenous Funding Stream (Ward All)
0:08:10 - HL8.2 - 2019 Toronto Urban Health Fund Allocations and Review Process (Ward All)
0:59:22 - HL8.3 - Toronto Urban Health Fund Funding Priorities and Objectives for the Years 2020 to 2026 (Ward All)
0:08:36 - HL8.4 - Public Health Implications of the Proposed Increase in Access to Alcohol in Ontario (Ward All)
1:02:46 - HL8.5 - Impact of Provincial Budget Announcement (Ward All)
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Well,
welcome
everybody.
We
have
quorum
so
we're
gonna
get
started.
Welcome
to
meeting
8
of
the
Board
of
Health,
two
members
of
the
boards
members
of
council
in
attendance
today,
as
well
as
members
of
the
public.
You
can
follow
the
agenda
and
debate
on
your
computer,
your
tablet
or
your
smartphone
at
Toronto
da
ta,
slash
council.
A
The
Board
of
Health
acknowledges
the
land
we're
meeting
on
is
the
traditional
territory
of
many
nations,
including
the
Mississauga's
of
the
credit,
the
Anishinaabe,
the
Chippewa,
the
Ho
nashoni
and
the
wend
at
people's,
and
it's
now
home
to
many
diverse
First,
Nations,
Inuit
and
maytee
people.
We
also
acknowledge
the
Toronto
is
covered
by
treaty.
A
Thirteen
with
the
Mississauga's
of
the
credit
I
I'm
gonna
begin
by
seeing
if
there
any
declarations
of
interest
under
the
municipal
conflict
of
interest,
Act
I,
seeing
none
can
I
have
a
confirmation
of
the
minutes
from
June
the
10th
2019
moved
by
Councillor
McKelvey,
all
those
in
favor
opposed.
If
any
carried.
We
have
a
number
of
presentations
at
today's
meeting,
so
we'll
walk
through
the
yellow
sheets
item
8.1,
Toronto
urban
health
fund,
indigenous
funding
stream.
We
have
a
presentation
and
speakers,
so
that's
held
item
8.2,
2019,
Toronto
urban
health
fund
allocations
and
review
process.
A
That
item
is
there
is
no
presentation
and
no
speakers.
I'll
move
the
staff
recommendations
moved
by
councillor
Leighton,
all
those
in
favor
opposed
if
any
that
carries
item
8.3,
trottle,
Urban,
Health
on
priorities
and
objectives
for
years,
2022
2026-
we
do
have
a
speaker
listed
on
that,
so
that
will
be
held
item
8.4
public
health
implications
of
the
proposed
increase
in
access
to
alcohol
in
Ontario.
A
A
B
A
C
C
E
C
When
we're
burning
medicines
and
we're
doing
a
smudge,
we're
really
we're
calling
in
the
grandmothers,
grandfathers,
helpers
and
and
spirits
to
come
and
be
present
and
for
us
all
to
connect
in
a
good
way,
but
also
connect
with
our
own
spirits
and
connect
with
each
other's
spirits.
And
so
we're
really
asking
everyone
to
come
together
in
a
good
way
and
connect
in
a
good
way.
So
meegwetch
for
your
time
and
and
and
we
appreciate
you.
F
We're
doing
this
from
sitting
down
I'm,
usually
standing
up,
so
please,
let
me
just
get
comfortable
for
a
second.
My
name
is
sharon
wit
rock
I'm
mohawk
I'm
Wolf
Clan,
my
family
comes
from
the
wata
Territory,
which
is
a
small
reserve
up
near
Owen
Sound
near
Perry.
Sorry
near
Perry,
sound
summer
is
going
to
burn
some
sage
and
she's
only
going
to
be
smudging
a
space,
we're
not
going
to
bring
it
around
to
each
individual
person.
Smudging.
The
space
helps
us
to
it's
literally
about
holding
space
for
good
conversation.
F
So
I
want
to
thank
you
for
allowing
us
to
have
the
opportunity
to
open
this
day
in
a
good
way.
I'm
gonna
really
quickly
just
acknowledge
the
four
directions
in
the
eastern
direction.
We
have
the
gift
of
vision
and
warmth
and
sunlight
because
the
Sun
satisfies
its
responsibility
every
day
by
rising
in
the
east
and
and
making
it
possible
for
us
to
have
life.
F
The
southern
direction
teaches
us
about
growth
and
development
and
the
way
that
we
do
that
as
adults
as
we
move
through
this
world
as
we
continue
to
grow
and
develop
our
minds,
it
gives
us
the
gift
of
knowledge
and
understanding
in
the
western
direction.
We're
taught
about
the
necessity
of
reflection.
F
At
the
end
of
the
day
when
the
Sun
is
going
down,
we
have
a
beautiful
opportunity
to
sort
through
the
details
that
have
happened
to
us
throughout
the
day,
and
we
can
take
an
opportunity
to
choose
which
lessons
we
will
carry
with
us
into
our
next
day,
in
which
we
will
leave
both
side
the
path.
So
we
don't
need
to
carry
them
with
us
and
if
we
spend
the
time
reflecting
on
those
events,
we
don't
carry
unnecessary
things
with
us
into
the
next
day.
F
The
northern
direction
teaches
us
about
spirit
and
moving
in
balance,
ensuring
that
there's
a
connection
between
the
truth
in
our
heart
and
the
truth
in
our
head.
When
we
feel
that
heaviness,
where
the
things
that
we
are
saying
or
doing,
don't
sit
right
with
us.
Sometimes
we
refer
to
it
as
a
gut
check
oftentimes.
It
means
that
our
heart
and
our
head
are
in
conflict
and
it's
important
to
sustain
balance
in
those
ways
and
in
those
ways
of
acknowledging
each
of
the
four
directions
and
the
gifts
it
brings
to
us
every
single
day.
F
It
allows
us
to
actually
have
access
to
those
spaces
of
balance.
So
thank
you
very
much
for
allowing
me
to
say
these
words
to
begin
the
day
and
I'm
excited
to
share
with
you
a
presentation
that
we've
built
that
describes
some
really
gratifying
and
valuable
work
that
we've
undertaken
as
an
indigenous
advisory
circle.
F
So,
as
I
said,
this
is
I'm
here
representing
the
advisory
circle
of
the
Toronto
indigenous
health
fund,
and
we
are
for
advisory
council
members.
The
interesting
thing
is
that
we
come
from
four
different
nations,
so
we
respect
we
represent
that
diversity
of
indigenous
community,
so
we
represent
the
indigenous
community
in
the
best
way
that
we
know
how
we
use
our
relationships.
We
use
our
voice
and
we
use
our
reputation
to
try
to
ensure
that
we're
effectively
and
responsibly
carrying
that
that
voice.
F
Following
that
in
the
fall,
there
was
the
formation
of
the
indigenous
advisory
circle
and
the
four
members
are
elder.
Ed
Bennett
who's,
unfortunately
not
able
to
join
us
today,
he's
under
the
weather,
myself,
Jessica,
Tamara
and
Alison
Luton
Berger,
who
you
will
hear
from
a
little
bit
later
on.
We've
had
11
meetings
and
we've
conducted
two
community-wide
consultations
and
we've
had
two
meetings
with
the
Toronto
Aboriginal
support
services.
Council.
F
Those
meetings
with
the
support
services
Council
were
an
integral
part
of
this
process
because
they
represent
the
interests
of
the
social
service
serving
indigenous
agencies
in
the
City
of
Toronto.
So
we
have
developed
some
operating
principles.
These
are
principles
that
that
dictate
exactly
how
we're
going
to
behave,
how
we
will
behave
responsibly
in
representing
the
needs
of
indigenous
community.
These
operating
principles
ensure
that
we
align
with
T
Haqq
and
that
we
are
our
primary
sort
of
goal
here
is
to
reduce
health
inequalities
for
indigenous
peoples.
Those
two
points
are
really
paramount.
F
F
F
We
are
hoping
to
influence
social
determinants
of
health
for
indigenous
populations,
and
that
requires
us
to
look
at
a
connection
in
terms
of
the
the
established
and
researched
social
determinants
of
health,
but
connecting
that
back
to
some
of
the
cultural
foundations
that
we
have
understanding
of
within
community
we're
hoping
to
improve
the
access,
improve
access
to
indigenous
healing
and
knowledge
and
practice.
For
a
long
long
time,
indigenous
knowledge
and
healing
has
been
sort
of
downplayed
for
within
mainstream
health
provision
processes.
F
So
it's
important
to
recognize
that
and
elevate
it
and
to
understand
the
validity
of
those
approaches,
we're
seeking
to
harmonize
indigenous
and
mainstream
health
programs
and
services,
so
that
talks
about
that
idea
of
connecting
those
two
worldviews
together.
There's
something
called
two-eyed
seeing,
which
means
that
we
have
to
have
an
understanding
of
how
to
see
the
world
through
sort
of
the
colonized
lens,
as
well
as
through
an
indigenous
lens.
F
So
that's
what
we've
attempted
to
do
at
every
step
of
the
way
as
well
and
we're
hoping
for
dedicated
resources
and
funding
for
indigenous
health
programs
and
services
to
support
a
coordinated
and
collaborative
system.
So
this
means
that
we're
looking
to
ensure
that
we're
sort
of
responding
to
the
existing
inequities
by
ensuring
that
there's
dedicated
resources,
the
key
features
of
the
indigenous
funding
stream.
These
are
sort
of
highlights.
It
was
a
complex
process
that
we
used
to
get
to
this
point,
but
the
key
features
how
it
is
different
from
the
existing
funding
model.
F
It's
a
it's
a
developed
funding
approach
with
priorities
that
use
a
holistic
framework
so
that,
as
I
described
earlier,
we
looked
at
original
sort
of
the
existing
tough
priorities
and
we
identified
how
those
are
aligned
with
indigenous
cultural
holistic
approaches.
We
clarified
some
eligibility
criteria
for
indigenous
organizations,
so
we
established
what
would
that
look
like
what
actually
constitutes
an
indigenous
organization?
F
We
ensured
that
all
of
the
approaches
that
we
used
were
accessible
and
culturally
relevant,
including
the
reporting
tools
and
the
application
process
itself.
That
was
one
of
the
benefits
of
having
such
a
broad
diversity
of
indigenous
council
members
on
the
circle.
We
looked
for
improved
flexibility
in
the
budget
for
indigenous
cultural
and
traditional
materials,
recognition
that
sometimes
indigenous
elders,
honoraria
or
you
might
need
to
purchase
tobacco
through
a
program
like
this.
So
we
need
to
make
sure
that
the
budget
would
be
able
to
permit
things
like
that.
F
We
defined
how
a
formation
of
an
indigenous
review
panel
what
that
might
look
like,
and
then
we
discussed
at
great
detail
tailored
support
for
project
successes.
So
this
talks
about
how
the
Toronto
urban
Health
Fund
would
support
successful
applicants
in
a
way
that
was
culturally
relevant
and
respectful.
F
The
next
slide
actually
shows
for
us
what
the
funding
model
looks
like.
So
this
describes
the
Toronto
urban
health
fund
stream
of
funding
stream
objectives.
The
existing
stream
was
three
categories
and
it
had
sort
of
bulleted
objectives
that
were
listed
under
each
of
these
three
categories.
What
we
actually
did
is
reimagined
many
of
the
objectives
that
a
that
existed
currently
and
we
interpreted
them
through
a
healing
wheel
process.
So
this
healing
wheel,
it
you'll,
see
other
healing
wheels
that
look
very
similar
to
this
one.
F
In
other
environments,
there
was
one
that
was
created
by
the
Aboriginal
healing
and
wellness
strategy,
which
was
a
very
large
strategy
that
involved
several
different
indigenous
community
members
agency
representation,
as
well
as
several
ministries
from
throughout
the
province,
and
it
was
one
of
the
first
of
its
kind
to
be
generally
accepted.
So
we
used
that
as
a
platform
to
understand
how
we
might
reinterpret
these
ideas
that
it
currently
exists
within
the
Toronto
urban
health
fund.
F
We
separated
them
into
four
directions,
which
means
that
we,
with
those
same
teachings
that
I
explained
to
you
this
morning
there
taken
into
consideration.
There
are
sections
that
allow
us
to
interpret
the
programming
from
a
physical,
mental,
emotional
or
spiritual
lens,
as
well
as
recognizing
that
these
programs
may
need
to
engage
anyone
along
any
stage
of
the
lifecycle.
F
All
of
the
work
that
we've
done
has
been
culture
based
and
community
driven.
We
ensured
that
we
had
many
many
really
good
philosophical
conversations
about
which
teachings
or
how
we
interpret
the
teachings
to
try
to
ensure
that
we
were
not
eliminating
anyone
from
being
able
to
integrate
or
participate
with
the
information
or
the
the
program
and
but
at
the
same
time,
making
it
as
widely
accessible.
So
again,
it's
a
holistic
model,
that's
consistent
with
indigenous
worldviews.
It
needed
to
be
flexible
so
that
community
response
could
be
driven
by
community.
F
The
community
itself
knows
and
understands
what
it
needs
in
order
to
respond
to
the
issues,
and
we
need
to
create
funding
frameworks
and
models
that
will
give
them
room
to
make
those
designs
and
activate
them.
Each
of
us
were
very
concerned
with
ensuring
that,
whatever
product
we
developed
was
a
trauma-informed
design,
I'm
not
going
to
explain
trauma-informed
approach
because
I'm
sure
that
that's
something
we
all
understand
and
we
wanted
to
again.
We
wanted
to
make
sure
that
it
was
inclusive
of
all
indigenous
peoples
and
life
stages.
F
F
That
that
does
not
need
to
be
defined
by
this
process
or
by
the
council.
It
needs
to
be
defined
by
those
organizations
themselves
and
that
any
non
eligible
indigenous
organizations
they
would
require
an
eligible
indigenous
sponsor,
so
we're
hoping
that
they
would
Trustee
their
work
through
an
indigenous
organization
that
is
qualified.
F
The
indigenous
funding
stream
review
panel-
this
is
an
interesting
sort
of
approach.
It's
a
very
small
review
panel
and
I
think
it's
necessarily
small.
We
have
four
members
of
the
indigenous
advisory
circle
which
you
can
see
around
the
outside
circle,
and
that
currently
is
the
existing
advisory
circle.
Members
that
we
have
right
now
for
review
panel
members
would
indicate
their
interest
through
an
expression
of
interest,
and
then
they
would
be
in
agreement
with
the
terms
of
reference
and
there
would
be
an
honour
area
provided
to
them
for
participating
on
the
review
panel
once
their
term.
F
F
The
review
panel
composition
would
include
obviously
terms
of
reference.
The
composition
itself
ensures
diverse
representation
from
within
the
indigenous
community
in
the
City
of
Toronto,
and
we're
looking
for
lived
experience,
and
that
lived
experience
is
something
that
is
mostly
open
to
interpretation
by
the
individuals
who
are
applying
and
we're
seeking,
as
I
said
for
members,
their
governance
and
decision
making
would
happen
through
a
non
defined
members
rule.
So
that
means
that
we
don't
necessarily
have
anyone
identified
specifically
as
a
chairperson
and
that
the
review
panel
would
be
able
to
identify
for
themselves.
F
F
One
of
the
first
processes
we
encountered
when
we
were
working
together
as
an
advisory
circle
was.
How
would
we
make
decisions?
This
process
was
actually
determined
and
created
by
the
indigenous
Advisory
Council,
with
support
of
an
facilitator
who
helped
us
to
identify
that.
What
we
really
wanted
to
do
was
to
have
full
consensus
amongst
our
council
members
and
that
that
might
take
things
a
little
bit
longer,
but
if
we
have
a
path
to
follow,
we
can
actually
get
there
in
the
end.
So
the
process
is
a
circular
process.
F
You
can
see
that
you
would
come
in
from
the
right-hand
side
there
a
decision
point
required
and
then
you
go
around
the
circle
and
the
members
could
be
I'm.
Gonna
use
the
term
loosely
could
be
pulled
to
identify
what
it
is
that
they're,
actually
what
their
feeling
is
on
whatever
the
decision
is,
and
then
we
would
work
in
a
circular
process
to
try
to
understand
what
are
people's
positions.
What
are
their
sticking
points?
F
The
indigenous
review
panel
would
assess
proposals
for
merit
with
tailored
and
standardized
tools
developed
using
indigenous
framework.
So
this
means
looking
at
those
that
that
healing
wheel
approach
that
we
talked
about
earlier,
using
that
as
a
criteria
of
understanding
what
the
applicants
are
asking
for,
but
there
would
also
be
conversation
with
the
applicants
to
specifically
give
them
an
opportunity
to
describe
what
it
is
that
they're
trying
to
achieve
through
their
application.
F
The
meetings
would
be
administered
through
the
City
Clerk's
office,
using
the
approved
City
Committee
procedures
and
that
there
would
be
an
elder
or
a
lead
of
indigenous
review
panel,
who
would
propose
make
recommendations
through
a
joint
report
with
tuff
and
their
review
panel
to
the
board
of
health
for
annual
approval,
the
project,
management
and
support.
This
was
something
that
was
really
important
to
us.
It's
one
thing
to
bring
a
life
into
this
world.
F
It's
something
else
entirely
to
take
care
of
it,
so
we
needed
to
make
sure
that
Toronto
urban
health
fund
was
going
to
be
able
to
support
these
projects
to
be
successful.
So
we
work
to
make
sure
that
Toronto,
Public,
Health
and
community
resources
are
available
for
successful
delivery
of
projects,
and
we
work
to
ensure
that
the
project,
management
and
evaluation
approach
within
the
applicants
were
appropriate
as
well
as
within
the
toronto
urban
health
fund.
F
We
advise
them
to
continue
to
build
and
sustain
partnerships
and
relationships
with
the
indigenous
service,
providing
community
to
make
sure
that
this
is
not
we're
not
coming
in
cold.
A
relationship
with
an
indigenous
organization
doesn't
begin
that
the
finalization
of
a
contribution
agreement
or
service
contract.
It
should
begin
considerably
sooner,
and
we
want
to
make
sure
that
we're
able
to
capture
successes
and
challenges
through
the
importing
and
evaluation
so
not
as
much
to
measure
the
value
or
the
I,
don't
know
how
to
putting
a
number
to
it
or
a
pass/fail.
F
The
launch
of
the
indigenous
funding
stream
were
aiming
for
2020
funding
cycle
and
it's
dependent
on
the
2020
public
funding
public
health
funding.
There
are
two
two
project
phases:
a
one-year
and
a
3-year
project
funding
cycle;
September
23rd
we're
hoping
to
be
able
to
open
the
expression
of
interest
and
then
November
25th
will
be
a
request
for
proposals
and.
A
D
F
F
Response
for
each
for
any
and
all
genders
and
life
stages,
so
the
existing
funding
model
was
could
be
interpreted
as
being
somewhat
restrictive.
Considering
there
was
one
particular
objective
that
said
for
child
and
youth
resiliency.
That
would
lead
you
to
believe
that
if
you
were
talking
about
harm
reduction-
or
you
know,
eliminating
substance,
use
or
abuse
that
maybe
children
and
youth
don't
belong
in
that
objective
category.
D
When
your
applications
come
in,
if
they
seem
like
they're,
more
heavily
weighted
towards
one
group
is
their
way
to
work
with
the
applicants.
To
maybe
broaden
you
know
so
as
to
many
come
in
for
women,
for
example,
that
you're
kind
of
brought
in
and
work
with
the
applicant
so
that
they
might
be
able
to
accept
a
wider
range
of
sure.
F
And
I
think
that
that
would
be
a
conversation
that
would
happen
during
the
application
process.
This
is
not
just
a
cotton
dry,
closed
application
process.
We've
encouraged
her
on
a
public-health
to
reach
out
and
ask
questions
and
to
have
those
conversations
during
the
application
process.
There
may
be
a
very
good
and
very
logically
founded
reason
to
focus
on
one
particular
demographic,
rather
than
keeping
it
broad,
but
it
is
worth
investigating.
So
it
would
be
a
question
that
would
be
had
during
the
application
process.
So.
D
E
E
F
Some
of
the
barriers
that
we
experience
throughout
this
entire
process
and
having
conversations
about
the
review
panel
members
as
well
as
the
advisory
circle,
it
has
to
do
with
the
people
who
are
best
situated
to
be
able
to
provide
those
supports
and
and
their
advice
and
their
wisdom.
They
tend
to
already
be
employed
in
other
places
and
their
employers
are
not
always
eager
to.
Let
them
do
this
kind
of
work.
You
know
off
the
dime
and
people
can't
always
afford
to
leave
their
job
to
do
it.
F
So
we
had
when
we
had
conversation,
one
of
those
two
conversations
with
the
Toronto
Aboriginal
support
services.
Council.
We
asked
the
the
executive
directors
of
indigenous
organizations
about
that
and
we
asked
them.
Would
it
be
possible
for
you
to
keep
them
on
payroll
or
if
we
can
provide
an
honour
area
for
their
time
and
that
they're
going
to
do
this
work?
If,
if
you're
going
to
keep
them
on
payroll,
when
they're,
when
they're
doing
this
service,
they
could
sign
their
their
honoraria
back
or
whatever
you
know.
Is
there
a
way
that
we
could
negotiate
that?
F
Could
they
be
permitted
as
as
your
as
the
employer,
and
we
received
some
encouragement
from
the
indigenous
organizations
executive
directors,
which
was
great
additionally,
it
goes
back
to
relationships.
So
when
I
talked
about
how
relationships
with
indigenous
organizations
doesn't
begin
at
the
contribution
agreement
or
the
service
contract,
it
begins
so
much
sooner.
So
what
that
means
is
that
Toronto
urban
health
fund
needs
to
be
present.
F
They
need
to
be
a
face
that
can
be
seen
by
indigenous
community
members,
both
within
who
worked
for
social
support
agencies,
as
well
as
clients
who
work
for
social
support
agencies
access
services.
So
what
that
could
mean
is
just
showing
up
to
a
GM's
showing
up
to
meetings
showing
up
to
do
volunteer
work
just
showing
up
and
having
a
face
once
that
the
community
becomes
familiar
with
seeing
these
people
and
recognize
them
as
being
trustworthy
and
reliable.
Then
it's
a
little
bit
more
of
a
reasonable
ask.
A
A
I
mean
not
only
for
your
time
in
the
presentation,
but
the
model
and
the
deep
care
and
thoughtfulness
with
how
it's
being
developed
and
I
think
that
it
really
when
we
started
down
this
path
as
the
Board
of
Health
in
2015
and
16
I,
don't
think
we
couldn't
imagined
such
a
comprehensive
and
thoughtful
mouth
model
to
be
developed,
and
now
the
onus
is
on
us
to
make
sure
that
we
can
see
it
through.
So
thank
you.
Thank.
F
A
So
we're
now
going
to
move
to
deputations.
We
have
two
speakers
and
our
first
speaker
is
Beth
Rachel
as'
from
the
and
I
apologize
for
the
mispronunciation
there
from
the
University
of
Toronto.
So
you
can
take
a
seat.
I
will
use
the
clock
now
that
we're
in
former
to
formal
deputation,
so
you'll
have
you'll,
have
up
to
five
minutes
and
there's
a
clock
you'll
see
on
my
right
and
you
can
begin
whenever
you're
ready.
B
B
We
know
that
HIV,
in
particular,
is
disproportionately
affecting
indigenous
peoples
in
Canada
in
2014
I
know
the
data
is
a
bit
outdated,
but
in
2014
there
were
eighteen
point:
two
new
infections
for
indigenous
people,
primarily
infecting
First
Nations
per
100,000
indigenous
people,
which
compared
to
6.2
for
non
indigenous
people.
So
we
know
that
it's
completely
disproportionate
in
at
the
same
time,
there
were
about
20%
of
all
new
infections
were
among
indigenous
people,
again
primarily
First
Nations,
and
we
know
that
indigenous
people
represent
what
four
percent
of
the
Canadian
population
so
we're
talking
huge
inequities.
B
I
can
tell
you
that
I've
done
a
lot
of
work
working
in
the
social
determinants
of
health,
and
you
cannot
treat
HIV
without
taking
into
consideration
the
social
determinants
of
health
that
includes
things
like
housing.
We
know
that
we're
dealing
with
the
massive
opioid
crisis
right
now
that
we
need
to
be
addressing
we're
talking
about
violence,
the
legacy
and
the
continued
ongoing
impacts
of
colonialism,
trauma
of
displacement
of
communities
from
their
families
and
any
program.
B
That's
going
to
work
needs
to
take
into
consideration
the
broader
social
determinants
of
health
and
needs
to
take
a
holistic
approach.
About
a
year
ago,
I
did
a
feasibility
study
as
part
of
a
non
indigenous.
A
non-governmental
organization
called
Dignitas
International,
which
I
had
worked
with
throughout
my
PhD
in
Malawi
and
I,
was
TAS,
was
looking
at
HIV
and
really
illnesses
among
indigenous
peoples
in
Canada,
and
this
involved
a
fairly
extensive
literature
review,
as
well
as
conversations
with
key
informants.
B
So
people
working
in
the
field
of
HIV
and
harm
reduction
throughout
Canada
and
I
can
tell
you
that
when
we
asked
what
works,
we
know
what
the
problems
are.
As
I
just
mentioned.
We
know
that
there's
huge
inequities
need
to
address
the
social
determinants
of
health,
but
I
can
tell
you
that
for
any
promising
practices
that
emphasize
indigenous
people's
right
to
self-determination,
anything
that's
community,
driven
that
comes
from
the
community.
That's
delivered
by
the
communities.
Anything
that
takes
a
holistic
approach
is
what
works.
Anything
that's
emphasized
as
cultural
safety
and
cultural
appropriateness
works.
B
So
whatever
the
you
know,
what
the
presentation
talked
about
in
terms
of
taking
and
focusing
on
indigenous
principles
is
it's
what's
gonna
work?
Priority
areas
include
increased
access
to
prevention,
treatment.
Indigenous
peoples
tend
to
do
worse
in
terms
of
HIV
care.
So
even
once
people
are
getting
tested
and
are
going
to
visit
a
doctor,
they
are
still
seeing
worse
outcomes
in
terms
of
being
less
likely
to
have
a
suppressed
viral
load,
which
means
that
the
virus
in
their
body
is
still
elevated
enough.
B
You
can't
treat
this
in
isolation,
harm
reduction,
HIV,
they
all
have
to
be
treated
together.
You
have
to
take
a
holistic
approach
and
I
want
to
support
I
guess,
I'm.
The
science
person
for
this
speaker
talk,
but
I
want
to
emphasize
that
any
cut
to
this
would
be
a
direct
violation
of
the
TRC
calls
to
action
number
23.
So
it
would
be
important
to
consider
that
if
we
are
going
forth
in
the
spirit
of
truth
and
reconciliation
and
I
will
stop
there.
B
G
Hallie
tow
truck
matching
truck
mass
I
hold.
You
fought
like
mount
a
lipoic
Chickasaw
say
a
Turkish
on
oppa
I,
don't
believe
a
choc
makyo
good
morning.
Everybody.
My
name
is
ELISA
Luton,
burger,
I'm,
Chickasaw,
Nation,
I'm
turtle,
clan
and
then
the
spirit
name
that
was
gifted
to
me
was
lucknow
holly,
pulchik,
meaning,
yellow
butterfly
woman.
G
I
want
to
thank
tough
for
all
the
support
they've
given
for
doing
this
hard
work
in
our
community.
The
indigenous
community
has
expressed
to
tough
through
consultations,
interviews,
feedback
and
their
refusal
from
some
organizations
to
apply
for
funding.
They
did
not
see
themselves
reflected
back
in
the
way
that
the
funding
program
currently
works.
Our
leaders
have
cited
concerns
around
cultural
competency,
project
reporting
and
evaluation
and
how
to
explain
the
importance
of
our
traditions
and
history
in
relation
to
health
promotion.
Work.
G
Tough,
is
always
responded
and
listened
to
these
concerns,
and
the
indigenous
stream
will
further
contribute
to
this
work.
This
effort
to
establish
an
indigenous
stream
to
have
it
developed
with
indigenous
people
instead
of
just
for
indigenous
people
and
the
care
that
has
been
demonstrated
around
consultation,
is
an
essential
step
forward.
The
indigenous
funding
stream
is
a
model
which
can
be
adapted
and
utilized
as
a
best
practice
for
working
with
indigenous
communities.
We
are
all
working
towards
wellness.
G
The
issue
we
have
run
in
is
the
need
to
balance
both
Western
and
indigenous
ways
of
knowing
doing
and
healing
the
default
is
often
to
assume
that
these
two
perspectives
stand
in
opposition
to
one
another
when
in
reality,
they
showed
different
ways
of
seeing
when
we
find
ways
to
integrate
the
two
of
them
together.
That
is
when
we
can
work
towards
the
healing
and
wellness
of
our
communities.
G
The
key
in
health
promotion
for
indigenous
people
is
reestablishing
our
connection
to
community
and
the
land.
This
concept
is
not
at
odds
with
resiliency
concepts
of
self-esteem,
self-efficacy
and
relationship
building
attending
ceremony
working
with
elders.
These
actions
are
all
about
learning
who
you
are
in
relation
to
the
world
around.
You
is
about
establishing
connections
with
support
in
the
community.
Who
will
help
you
walk
that
good
path.
G
What
is
missing,
though,
is
that
we
need
to
leave
space
for
our
people
to
advocate
for
what
they
need.
As
a
youth
worker
I
know
that
our
community
is
intelligent,
they
carry
wisdom
and
they
know
what
they
need
to
be
well.
We
know
that
the
path
that
needs
to
be
taken,
but
we
need
to
see
that
path
is
accessible,
non,
oppressive
and
supportive
of
our
voices
in
the
tough
projects
I
currently
supervise.
We
endure.
We
engaged
youth
holistically
through
substance
use
circles,
health
promotion,
programming,
ceremony,
youth,
led
Risk,
Reduction
programming
and
youth
governance.
G
Programs
that
are
community
led
are
essential,
as
our
programs
that
understand
that
wellness
does
not
only
exist
for
one
facet
of
ourselves.
We
need
to
be
looking
at
help
from
all
aspects
to
develop
and
strengthen
resilience.
The
work
that
we
are
doing
is
no
longer
simply
about
prevention
and
promotion.
Our
communities
are
facing
things
that
make
them
unwell
and
we
are
faced
with
an
overwhelming
need
to
find
new
solutions
that
are
rooted
in
our
culture
and
in
our
history.
G
We
are
no
longer
looking
just
at
our
current
health
status,
but
also
asking
what
does
our
community
need
to
be
healthy
in
the
next
year?
The
next
five
years,
the
next
10
years
and
the
next
seven
generations?
The
indigenous
funding
stream
will
give
us
the
support
to
look
at
harm
reduction,
barriers
and
HIV
risk
factors
facing
our
community
and
a
holistic
sense.
G
It
will
allow
us
to
see
beyond
the
simplistic
solution
of
providing
harm,
reduction,
supplies
and
workshops
and
allow
us
to
create
programs
which
look
at
the
holistic
wellness,
meaning
the
mental,
physical,
emotional
and
spiritual
wellness
of
our
communities.
This
work
is
essential
because
it
creates
opportunities
for
programs
to
be
developed
which
do
not
simply
respond,
react
or
band-aid,
but
allow
us
to
be
proactive
and
improving
indigenous
health
and
Terron.
G
No,
the
funding
stream
will
allow
us
to
connect
indigenous
traditions
with
intervention
techniques
in
a
way
which
is
supportive,
acknowledges
our
own
expertise
and
was
created
for
us,
but,
more
importantly,
with
us
these
concepts.
These
concepts
are
essential
as
we
move
forward
towards
reconciliation,
and
the
stream
is
a
major
step
where
we
can
meet
to
walk
this
path
together.
Side
by
side.
A
Thank
you
very
much.
Are
there
any
questions?
Melissa?
Okay,
thank
you.
So,
at
this
time
we're
gonna
move
it
into
committee.
Then,
are
there
any
members
additional
members
of
the
public
who
would
like
to
speak
all
right?
Thank
you.
Seeing
none
we're
gonna,
move
it
into
committee.
Questions
of
staff.
A
All
right,
I'm
gonna,
put
myself
on
the
list.
I
have
a
few,
so
just
so
I
can
understand
so
the
history
in
2015
the
board
began
by
looking
at
how
we
could
enhance
outreach
to
indigenous
organizations
towards
tough
funding
which
led
to
exploring
the
feasibility
and
design
of
a
specific
funding
stream,
which
has
been
led
to
this.
The
proposal
here
in
front
of
us
today
so
right,
yes,.
A
If
I
jump
ahead,
I
just
want
to
understand
so
item
8.3,
which
has
our
urban
health
fund
priorities
and
objectives
for
2020
to
2026
I,
see
three
funding
objectives:
prevention
of
HIV
harm
reduction
in
child
and
youth
resiliency.
Where
does
this
this
new
fun
indigenous
funding
stream
fit
into
that?
Because
I'm
looking
here
and
I
only
see
those
three
so.
H
With
respect
to
those
areas,
those
are
areas
of
priority
areas
of
focus
that
the
fund
actually
seeks
to
address.
What
we're
talking
about
here
is
a
new
funding
stream
and
it
would
be
dedicated
funding
specific
to
meeting
the
needs
of
indigenous
populations
in
respect
of
those
three
priority
areas
that
have
been
the
long-standing
priorities
of
the
toronto
urban
health
fund
and
continue
to
be
the
priorities
as
you'll
see
in
the
upcoming
work.
Okay,.
A
Then
I
guess
given
that,
given
that-
and
we
saw
in
the
presentation
from
the
indigenous
advisory
circle,
the
new
funding
for
the
specific
stream
is
dependent
on
future
funding
discussions
with
the
board
is:
should
we
not
have
a
motion
going
through
to
Budget
Committee
on
this
I
mean
what
we
always
every
year,
a
budget
we
get
our
new
and
enhanced
less.
If
it's
not
baked
in
how
do
we
ensure
that
we're
doing
everything
possible
to
have
this
as
a
potential
item
be
it
funded
or
an
enhanced
funding
request?
So.
H
A
H
A
D
Thank
You,
chair,
Cressy,
okay,
so
my
question
kind
of
follows
on
on
what
you
had:
what
is
the
total
of
what
we're
putting
in
the
urban
health
fund
allocations
right
now,
so
I
know
it
links
more
with
8.2,
but
if
there's
a
motion
coming
on
this
I
think
we
have
to
have
a
more
fulsome
conversation
on
what
that
is.
So
what's
that
amount
right
now,
so.
H
Through
the
chair,
I
can
tell
you
what
we've
got
on
on
the
table
for
2019,
so
for
the
one
year
projects
it's
about
seven
hundred
and
seventy
thousand
dollars,
and
for
the
three
year,
the
third
year
of
the
three
year
projects
it's
about
2.4
million
I'm.
Looking
over
at
my
staff
and
those
are
rough
figures.
I,
don't
have
all
the
you
know,
high
level
summary
770,000
for
the
one
years
and
for
the
third
year
of
three
year,
projects
2.4
so.
H
Through
the
chair,
I
think
that
will
depend
on
the
deliberations
that
we
have.
We
also
need
to
think
about
that
which
our
province
is
doing.
We
do
have
an
upcoming
report
later
on
today's
agenda
in
respect
of
the
provincial
budget
announcement.
So
it's
a
little
premature
for
me
to
say
specifically
what
we're
looking
at
in
total.
D
H
H
So
yes
to
be
clear
when
I
say
budget
committee
I
mean
the
Board
of
Health
Budget
Committee
September
towards
the
end
of
September
this
year,
then
that
committee
reports
here
to
the
broader
Board
of
Health
and
in
turn
a
recommendation,
is
made
and
you'll
hear
more
about
this
in
an
upcoming
presentation,
just
a
little
bit
later
in
today's
agenda
on
what
the
entire
budget
process
code
looks
like,
but
that
would
include
that
it
has
to
go
through
the
city
budget
process.
Ultimately,
thank
you.
I.
A
E
The
Aboriginal
Affairs
Committee
recommended
that
the
Board
of
Health
review
its
urban
health
fund,
as
it
relates
to
in
indigenous
funding,
and
so
I
actually
believe
that
that's
where
the
genesis
or
I'd
like
to
think
that
that
small,
but
mighty
community
council
consultation
committee
provided
that
direction
to
the
Board
of
Health,
and
it's
not
because
I
co-chaired
the
committee
and
helped
write
the
recommendation,
but
that
it's
nice
to
see
it
come
back
like
it's.
It's
it's
nice
to
see.
It's
been
a
long
time,
but
it's
it
happened
and
it
went
through.
E
It
went
through
what
what
I
think
is
a
rigorous
and
responsible
way
of
developing
policy,
and
this
was
for
a
number
of
reasons.
One
was.
There
was
a
concern
that
the
existing
urban,
the
existing
urban
health
fund,
wasn't
capturing
the
need
within
the
indigenous
community
in
in
Toronto
and
how
the
money
was
being
allocated
for
to
target
in
the
indigenous
community.
It
wasn't
reflective
of
the.
E
Principles
and
and
and
sort
of
foundational
thought
in
indigenous
thought,
and
so
it
came
from
one
of
our
members
and
I-
know
that
they're
gonna
be
pleased
that
they
that
this
has
gone
through
this
process
and
is
coming
back.
But
I
wanted
to
broad
that
small
small
historical
footnote
to
the
development
of
this
policy
and
then
just
make
a
couple
of
remarks.
E
One
another
reason
it
came
out
of
the
committee
was
this
is
reflective
of
not
only
the
2010
statement
of
commitment
to
indigenous
people
that
the
City
of
Toronto
made
in
working
closer
and
building
capacity
amongst
indigenous
led
organizations,
but
it's
also
reflective
in
the
in
the
truth
and
reconciliation
calls-to-action
and
while
I'm
not
intimately
familiar
with
the
inquiring
of
missing
and
murdered
indigenous
women
and
girls
I
can
guarantee
you
it's
in
there
in
the
calls
to
justice
that
we
develop
specific
months.
I
can
all
but
guarantee
you
that
that
it
is
there.
E
E
E
Think
it's
a
good
lesson
that
those
are
the
conversations
you
you
you
have
as
a
group
as
you
try
to
make
it
to
a
consensus
position,
not
that
they
all
end
up
being
yeses
at
the
end
of
the
day.
But
you
have
an
opportunity
to
fully
discuss
them.
So
it's
nice
to
see
that
represented
in
that
way
and
and
now
documented,
so
that
we
can
share
it
with
others.
A
But
for
too
long
we've
missed
a
focus
here
and
a
focus
that,
as
has
been
alluded
to
the
TRC
recs
have
said,
needs
to
be
addressed.
And
so
what
I
really
appreciate
about
what's
in
front
of
us
here,
is
that
the
design
of
the
model
has
been
what
one
that
really
speaks
to,
and
we
said
earlier
the
principle
of
nothing
about
us
without
us
that
this
it
wasn't
simply
about
saying
we're.
Adding
a
new
funding
stream
hope
it
works
out.
A
8.3,
which
we're
gonna
be
dealing
with
next
is
where
we're
talking
about
the
funding
priorities
and
objectives
for
2020,
226
and
I
will
have
an
amendment
coming
around
ensuring,
even
though
I
trust
that
staff
are
going
to
be
doing
their
work
internally,
given
how
how
long-standing
a
priority
this
is
mean
to
bring
forward
that
request.
I
want
to
make
sure
that
that
is
captured
and
we
do
not,
as
a
board
lose
sight
of
it.
So
I'll
have
an
amendment
on
that,
though
it
will
be
as
we're
going
to
hear
later
in
this
and
agenda.
A
It
is
an
uncertain
budget
year
uncertain
because
the
province
is
still
trying
to
figure
out
what
it
believes
when
it
relates
to
public
health,
and
so
we
will
do
our
part
to
ensure
that
public
health
writ
large
and
the
indigenous
stream
as
a
focus
are
both
protected,
but
there
is
still
uncertainty,
and
so
there
is
work
ahead
for
us
with
that.
I
think
we
conclude
there
isn't
there's
not
even
a
motion
for
receipt.
A
This
was
solely
a
presentation,
so
thank
you
again
to
the
deputies
in
the
circle
and
we're
now
going
to
move
on
to
our
next
item.
We
do
need
to
receive
it.
Can
I
have
a
mo
director
lie
motion
for
a
seat
all
those
in
favor
opposed
penny
carried.
Okay,
we're
now
gonna,
move
on
to
item
8,
the
Toronto
urban
health
fund,
funding,
priorities
and
objectives
for
years,
20
22,
20
26.
We
do
not
have
a
presentation,
but
we
do
have
a
registered
speaker.
A
Okay,
seeing
none
over
I
will
kick
it
off
and
I
have
an
amendment,
and
that
is
for,
if
it
can
be
put
on
the
screen
that
the
Board
of
Health
request
the
medic
requested
the
medical
officer
of
Health
to
include
422,000
for
the
toronto
urban
health
fund,
indigenous
funding
stream.
Sorry
no
8.2
was
endorsed.
A
And
that's:
okay:
did
you
have
questions
on
8.3
before
I
pick
it
up?
No
okay!
So
it's
two
incresed
that
the
MOH
include
the
420
mm.
We've
just
talked
about
for
the
indigenous
funding
stream
in
Toronto,
Public
Health,
2020
operating
budget
submission
what
this
four
members
of
the
board,
if
you're
new
to
the
board
this
term,
the
way
in
which
we
run
through
the
budget
process.
A
Here
we
have
a
special
Board
of
Health
Budget
Committee,
where
we
work
with
Toronto
Public
Health
staff
to
oversee
their
budget
submission
and
we're
gonna
have
a
presentation
coming
on
that
later
on
the
agenda.
So
we
as
the
Board
of
Health
Budget
Committee,
and
then
this
Board
of
Health.
We
endorse
our
budget
and
then
that
is
submitted
to
the
city
to
go
through
their
process,
and
so
we,
it
is
we're
in
an
uncertain
budget
time.
A
In
this
uncertain
times,
I
think
you're
gonna
have
to
fight
like
heck
to
ensure
that
the
Toronto
urban
health
fund
continues
to
be
funded
on
a
go-forward
basis
and
that
it
is
expanded
to
include
the
indigenous
funding
stream
that
we've
worked
so
hard
to
interpret
to
bring
forward.
So
those
are
all
my
comments
here.
Does
anybody
else
wish
to
speak?
A
A
We
are
now
moving
on
to
our
final
item
of
the
morning,
and
that
is
that
which
we've
referred
to
a
number
of
times
this
morning,
which
is
item
8.5,
the
impact
of
the
provincial
budget
announcement
and
we're
gonna
start
with
a
presentation
from
our
staff.
But
before
that,
are
there
any
members
of
the
public
here
who
wish
to
speak
on
item
8.5?
We
don't
have
anybody
registered
okay,
seeing
none
I'll
turn
it
over
to
you,
dr.
hill.
H
H
There
was
an
April
18th
discussion,
hosted
by
the
Ministry
of
Health,
then
Ministry
of
Health
and
long-term
care,
and
they
communicated
changes
to
local
boards.
Of
health
around
the
cost
sharing
model
again,
the
April
11th
announcement
provided
no
details.
Details
started
to
emerge
thereafter.
The
first
opportunity
for
that
was
April,
18th
and
you'll
see.
H
The
changes
are
the
specific
nature
of
the
cost-sharing
changes,
as
shown
here
on
this
slide,
and
what
I
would
like
to
call
your
attention
to
is
that
first,
there
was
a
retroactive
nature
to
the
changes
that
were
proposed
by
the
provincial
government.
This
was
an
announcement
made
on
April,
18th
and
you'll,
see
the
changes
dated
back
to
April.
The
first
and
I.
H
Moving
then
to
May
27th
we're
still
on
the
recap.
The
premier
held
a
televised
press
conference
and
made
some
announcements
which
were
characterized
as
a
reprieve
on
the
retroactive
nature
of
the
change
in
the
cost-sharing
model,
and
there
was
communication
specifically
received
by
the
City
of
Toronto,
in
which
the
premier
indicated
that
this
reprieve
would
allow
for
the
opportunity
for
municipalities
and
Toronto,
in
particular,
to
work
with
the
province
to
transform
certain
critical
public
services
and
find
efficiencies
that
would
sustain
sustainability
on
an
ongoing
basis.
H
Unfortunately,
very
little
by
way
of
detail
outside
of
what
I
just
described
on
the
last
slide
was
provided
in
that
May
27th
announcement,
and
we
have
continued
to
reach
out
to
colleagues
at
the
provincial
government
and
at
the
Ministry
of
Health
in
particular,
to
get
more
details.
But
there
are
still
a
number
of
items
that
I
feel
we
need
to
negotiate
or,
at
the
very
least,
confirm
with
our
provincial
partners
and
those
things
are.
We
need
to
confirm
one
or
negotiate
the
funding
envelope.
H
What
are
those
figures
going
to
be
particularly
for
2020
and
for
2021,
which
is
the
year
in
which
the
provincial
government
had
proposed
that
we
go
to
that
5050
model,
the
unique
and
different
cost-sharing
ratio,
specifically
for
Toronto
and
finally,
what
proportion
of
the
200
million
dollars
in
savings
that
is
expected
to
be
affected
for
the
entire
Public
Health
System
in
the
province?
What
proportion
of
that
savings
is
meant
to
be
achieved
for
by
us
Toronto,
Public
Health?
These
are
things
I,
think
that
need
to
yet
be
sorted
through.
H
In
addition
to
the
may
27th
announcement,
there
have
been
some
other
developments
that
affect
us
directly
at
Toronto,
Public
Health.
For
starters,
we
have
received
a
funding
letter
which
indicates
that
the
amount
that
we
should
expect
to
receive
for
Toronto
Public
Health,
specifically
for
the
low-income
seniors
dental
program
that
the
province
announced
is
for
2019
2020.
The
funding
that
we
should
expect
to
receive
is
15
million
five
hundred
and
forty
three
thousand
three
hundred
dollars.
H
The
province
is
currently
holding
information
sessions
with
the
various
public
health
units
and
who
will
ultimately
be
the
providers
and
administrators
of
this
service,
but
specific
details
of
the
program
have
yet
to
be
provided
in
those
information
sessions.
I
think
it's
important
for
the
board
to
note
that
what
will
be
especially
interesting
and
important
for
us
to
know
is
what
exactly
is
contained
in
that
basket
of
services
right
and
what
are
the
terms
under
which
those
services
might
be
provided
to
low-income
seniors.
H
H
H
What
my
role
and
responsibilities
is
as
the
medical
officer
of
health
and
respect
of
budget
issues,
the
role
of
City
Council
and
how
these
roles
and
responsibilities
manifest
themselves
in
respect
of
Toronto,
Public,
Health
programs,
services
and,
ultimately,
our
budget,
so
I
just
by
way
of
and
again
this
is
not
meant
to
be
a
comprehensive
discussion
on
governance.
I
will
not
belabor
the
point
just
to
provide
you
with
a
high-level
summary.
H
First
and
foremost,
the
Board
of
Health
is
governed
by
the
Health
Protection
and
Promotion
Act
in
its
regulations
and
as
well
by
the
City
of
Toronto
Act
and
all
the
bylaws
have
come
associated
with
that.
Just
to
remind
the
members
of
the
Board
of
Health,
the
health
protection
and
promotion
act
states
that
the
Act
provides
for,
and
I
quote
the
organization
and
delivery
of
public
health
programs
and
services,
the
prevention
of
the
spread
of
disease
and
the
promotion
and
protection
of
the
health
of
the
people
of
Ontario.
H
You
how
this
interfaces
with
the
City
of
Toronto
act?
Well,
the
City
of
Toronto
act
establishes
the
Board
of
Health,
provides
for
establishing
the
size
and
appointments
to
the
Board
of
Health
and
describes
the
function
of
City
Council
in
respect
to
myself,
as
the
medical
officer
of
Health
provides
resources
to
the
board
in
order
to
fulfill
its
duties
under
the
health
protection
and
promotion
Act.
Those
that
which
I
just
described
to
you
earlier
and
City
Council
also
plays
an
important
role
in
terms
of
appointing
the
board's
auditor.
H
So
when
we
try
to
look
at
these
things
all
put
together,
the
Board
of
Health
is
ultimately
held
accountable
by
the
province
to
provide
programs
and
services
as
prescribed
by
the
Health
Protection
and
promotion
act,
and
that
act
itself
is
further
supplemented
by
the
Ontario
Public
Health
standards
and
its
associated
protocols.
I
think
it's
important
for
you
to
note
as
well
that
the
Board
of
Health
does
have
authority
under
the
health,
protection
and
promotion
act,
and
its
section
9
of
that
act
in
particular.
H
That's
served
by
the
Board
of
Health,
and
it
also
has
to
be
the
case
that,
in
order
to
provide
those
optional
programs
and
services
that
City
Council
approved
the
provision
of
that
health
program
or
service
and
again
just
to
highlight
what
my
role
is
and
what
my
responsibilities
are
in
respect
of
all
this
work
that
we
need
to
do.
Given
that
budget
is
an
important
conversation
or
a
particularly
important
conversation
for
us
this
year,
as
medical
officer
of
Health
I
have
a
bit
of
a
dual
role
here.
H
First
and
foremost,
I
have
to
report
to
you
as
the
board
on
issues
related
to
public
health
concerns
and
how
best
to
address
those
particular
concerns
bringing
to
bear
the
best
available
evidence
on
how
to
address
those
issues.
I
also
have
a
role
in
executing
a
fiduciary
responsibility
regarding
the
funding
provided
by
the
province
and
the
city
in
terms
of
the
delivery
of
public
health
programs
and
services,
so
taking
us
through
to
the
next
slide.
H
I
think
it
addresses
some
of
the
issues
that
director
McKelvey
raised
in
a
question
on
an
earlier
agenda
item
a
little
bit
about
the
Board
of
Health
budget
process
and
how
it
actually
works,
and
how
our
deliberations
here
at
this
table
impact
the
Toronto
Public
Health
budget
and
how
that
actually
comes
into
being.
This
basically
takes
you
through
a
high-level
summary
of
the
Board
of
Health
budget
process
and,
as
you
see,
it
starts
off
with
the
recommended
budget
that
we
put
forward
to
the
Board
of
Health
Budget
Committee.
H
This
is
made
by
a
but
it's
a
budget
that's
put
together
by
Toronto
Public
Health
staff,
with
significant
input
from
our
senior
management
team
at
Toronto,
Public
Health.
We
bring
that
forward
to
the
Board
of
Health
Budget
Committee,
who
has
the
opportunity
to
review
that
recommended
budget,
provide
advice
to
me
in
respect
of
that
recommended
budget
and
has
the
opportunity
to
then
recommend
in
whole
or
in
part
that
budget
to
the
rest
of
the
Board
of
Health.
H
Consider
the
budget
committees,
recommendations
and
then
recommend
in
whole
or
in
part
the
budget
which
then
in
turn
goes
excuse
me
through
the
city's
budget
process
so
effectively.
What
happens
is
that,
at
the
end
of
the
board
of
health
process,
the
board
recommends
a
complete
operating
budget
with
staffing,
complement
and
a
capital
budget,
and
that
has
to
go
through
the
city's
budget
process.
I
should
point
out
that,
while
service
levels
are
discussed-
and
this
was
part
of
the
discussion
that
we
had
at
last
week's
Board
of
Health
Budget
Committee
meeting-
hence
I'm
bringing
it
forward.
H
So
there
are
service
levels
for
those
of
you
who
have
not
yet
had
the
pleasure
of
going
through
one
of
these
budget
processes.
There
are
service
levels
that
are
described
in
the
budget.
Analyst
notes.
I
should
advise
you,
though,
that
they
are
not
entirely
exhaustive
in
terms
of
what's
covered,
and
it's
they're,
not
exhaustive
in
terms
of
all
the
programs
and
services
that
Toronto
Public
Health
provides.
H
So
what
that
means
is
that
we
we
have
this
range
of
service
indicators
and
expectations,
sometimes
very
details,
sometimes
very
high
level,
when
you
look
at
the
budget
documentation
and
that
what
you're
approving
whether
you're
a
member
of
the
Board
of
Health,
Budget,
Committee
or
the
Board
of
Health,
and
when
you
tie
when
I
say
approving
it's
recommending,
then
to
the
next
level
of
the
budget
process.
I
think
what
happens
even
within
the
context
of
the
Ontario
Public
Health
standards
and
the
protocols
they
too
are
sometimes
extremely
detailed
and
sometimes
a
little
higher
level.
H
In
respect
of
what
the
service
level
indicators
are
or
service
level,
expectations
might
look
like,
and
what
this
allows
for
is
that
it
allows
for
local
public
health
jurisdictions,
each
local
public
health
agency
to
determine
what
makes
the
most
sense
within
their
context.
It
gives
some
latitude
in
how
programs
and
services
are
delivered
and
how
service
expectations
and
indicators
are
achieved.
So
the
simplest
way
for
me
to
describe
this
in
a
very
concise
way
is
to
say
that
say.
For
example,
we
have
a
program
that
has
traditionally
taken
ten
FTEs
or
20
FTEs
to
deliver.
H
Let's
use
the
number
20.
If,
in
fact,
we
have
a
new
technology
that
then
allows
for
a
smaller
number
of
FTEs
to
deliver
that
program.
Then,
by
having
you
know,
general
service
level,
expectations
and
indicators
were
afforded
the
opportunity
to
do
what
makes
most
sense
to
continue
to
deliver
the
program,
but
to
take
the
resources
that
might
have
been
used
before
in
a
more
manual
process
that
have
now
been
more
automated
as
a
result
of
new
technology,
reduce
the
FTE,
complement
there
and
then
provide
the
resources.
H
So
moving
now
through
to
the
City
of
Toronto
budget
process,
the
city's
budget
process
has
three
stages
and
they're
outlined
here
on
this
slide
important
for
the
Board
of
Health
members
to
know
that,
while
there
is
this
very
delineated
process,
the
budget
put
forward
by
the
Board
of
Health
can
be
changed
at
any
given
time
in
the
process.
City
Council
ultimately
holds
the
authority
and
has
the
opportunity
and
responsibility
for
approving
the
operating
budget.
The
staffing
complement
and
the
capital
budget
for
Toronto
Public
Health.
H
Just
to
give
you
a
little
more
detail
on
that
Council's
approval
of
the
operating
budget
includes
three
components:
the
gross
operating
amount,
the
net
operating
amount
at
a
program
level
and
the
staffing
complement,
so
the
room
has
gotten
very
quiet.
Walking
through
a
budget
process
tends
to
do
that.
I
H
H
H
So
now,
turning
to
the
2020
financial
pressures,
this
is
again
based
on
the
last
written
communication
that
we
have
and
looking
forward
to
the
2020
financial
pressure.
That's
estimated
to
be
in
the
range
of
19
million
to
70
million
for
2020.
As
you
can
see
here,
delineated
on
the
slide,
the
city
will
actually
need
to
increase
in
its
investment
in
public
health,
from
43
million
to
63
million
if
it
is
to
be
able
to
maintain
a
170
million
dollar
funding
envelope
at
heed
a
60-40
caution
model.
H
So
that
is
a
quite
sobering
I
think
for
all
of
us.
It
certainly
is
for
those
of
us
at
Toronto,
Public
Health,
but
in
order
for
you
as
a
board
to
understand
how
we
develop
particular
strategies
in
order
to
deal
with
these
pressures
and
what
sorts
of
actions
we
might
take
over
and
above
understanding,
what
the
budget
process
is,
I
think
it's
important
for
you
to
know
what
actually
goes
into
our
Toronto
public
health
budget.
H
H
We
are
an
agency
that
conducts
its
functions
through
people
through
professional
staff,
so
that
accounts
for
a
significant
proportion
and,
as
you
see
here
on
this
slide,
it's
roughly
75
percent
of
our
budget
about
20
percent
of
our
budget
goes
towards
non
payroll
expenses
and
there
are
some
subcategories
broken
out
for
you
on
the
slides.
We
have
contracted
services
delivered
by
community
agencies
comprising
about
8%
6%,
going
to
grants
like
the
student,
nutrition
programs
and
finally,
at
the
bottom
of
the
slide.
H
So
what
does
that
mean
in
terms
of
strategies
for
us
at
Toronto,
Kel's
well
for
2019?
What
we
are
doing
thus
far
is
holding
not
surprisingly
on
discretionary
expenditures,
some
of
which
are
listed
here
on
this
slide.
This
I
think
is
a
reasonable
step
to
take
within
the
context
of
an
uncertain
financial
picture,
and
we
know
that
we
have
pressures
we
still
have
yet
to
hear,
as
I
mentioned
earlier
from
our
provincial
partners.
H
You
know
some
conformation
around
what
we
believe
to
be
the
case.
We're
also
looking
at
how
we
can
manage
the
pressure
through
managing
our
existing
resources,
and
we
know
that
we
have
a
significant
amount
of
attrition
as
part
of
our
workforce
complement,
and
this
occurs
naturally.
So
what
we're
trying
to
do
is
look
at
different
strategies,
including
attrition
such
that
we're
able
to
manage
the
financial
pressures,
but
in
a
way
that
doesn't
negatively
impact
on
the
health
status
of
the
people
that
we
serve.
This
is
fundamentally
you
know.
H
These
are
significant
figures
for
us
at
Toronto,
Public,
Health
and,
as
a
result,
the
kind
of
financial
pressure
we're
speaking
of
is
significant.
So
we
are
developing
strategies
and
options
on
how
this
pressure
could
be
addressed.
We
had
some
opportunity
to
discuss
that
at
the
most
recent
Board
of
Health
Budget
Committee
meeting,
but
I
did
want
to
take
the
opportunity
to
provide
the
broader
board
with
a
sense
as
to
what
strategies
are
currently
under
consideration,
and
this
is
just
a
high
level
overview.
H
You
know
we're
not
getting.
The
plan
is
not
to
get
into
details
at
this
stage
of
the
game.
At
this
forum,
however,
I
did
want
the
board
to
know
that
there
are
some
strategies
that
were
thinking
through
and
I
wanted
to
take
you
through
a
high-level
summary
on
each
of
these
specific
details
on
each
of
these
strategies
and
options
will
be
provided
to
the
Board
of
Health
Budget
Committee
as
part
of
the
2020
budget
process
and
at
the
subsequent
Board
of
Health
Budget
Committee,
which
occurs
in
September.
H
So
turning
now
to
the
high-level
summary
on
the
strategies
that
we're
seeking
to
deploy
to
manage
the
financial
pressures
on
the
go
forward
basis,
as
I
mentioned
to
you
earlier,
we
have
a
provincial,
low-income,
seniors
dental
program
announcement
with
some
dollars
attached
to
it
details
still
as
I
mentioned
earlier,
you
know
being
fleshed
out.
We
don't
have
very
much
by
way
of
detail,
don't
know
what
the
basket
of
services
is
still
don't
have
many
of
the
terms
of
engagement
for
clients
and
and
in
terms
of
eligibility.
H
H
Looking
at
some
other
strategies,
we
are
considering
new
revenue
sources.
I
think
we
have
an
opportunity
to
identify
new
revenue
sources
and
to
think
about
revenues
where
we
haven't
traditionally
or
charging
where
we
haven't
traditionally
charged,
whether
we're
talking
about
charging,
for
you
know
rien,
spec,
shion's
or
other
services
that
we
currently
provide.
H
H
I
think
we
have
an
opportunity
to
discuss
with
our
provincial
counterparts
the
introduction
of
new
information
systems
that
actually
allow
us
to
gain
some
in
administrative
efficiencies.
None
of
these
are
short-term
or
quick
turnaround
in
Devers,
but
I
think
we
would
be
remiss
if
we
didn't
take
that
opportunity.
I
think
we
can
also
do
such
things
as
negotiate.
Some
funding
around
functions
that
have
been
downloaded
either
directly
from
the
province
or
from
the
federal
government
to
the
province
to
us.
H
Finally,
there
are
another
bucket
of
other
strategies
that
are
currently
under
development
in
order
to
address
the
financial
pressures
that
we
see
coming
in
2020
and
beyond.
There
was
an
organizational
review
that
we
conducted
at
Toronto,
Public
Health,
at
the
behest
of
City
Council
as
part
of
its
2017
budget
process.
It
was
one
of
the
recommendations
that
council
had
asked
for
Toronto
Public
Health
to
undertake.
We
completed
that
organizational
review
at
the
end
of
last
year,
but
did
not
have
the
opportunity
to
implement
it.
H
We
could
consider
implementing
select
recommendations
from
that
again
as
a
means
by
which
to
address
financial
pressures.
We
are
certainly
looking
at
proposed
changes
to
our
programs
and
services,
whether
we're
looking
at
the
effectiveness
of
those
programs
or
changing
the
method
by
which
we
deliver
some
of
these
services
in
order
to
address
our
financial
pressures.
I
think
these
are
some
other
methods
by
which
we
can
seek
to
manage
again
very
significant
financial
pressures
for
2020
and
beyond.
H
We
are
actively
collaborating
with
the
association
of
local
public
health
agencies
and
the
Council
of
medical
officers
of
Health
of
Ontario.
We
are
not
the
only
local
public
health
agency
that
is
dealing
with
these
pressures.
We
have
unique
circumstances.
I
told
you
that
we
did,
we
were
advised,
or
what
has
been
proposed
by
the
province,
is
a
different
and
unique
cost-sharing
model
for
the
City
of
Toronto.
H
So
we
do
have
a
unique
circumstances
that
other
local
public
health
agencies,
quite
frankly,
are
not
dealing
with.
They
have
some
other
challenges
that
we
in
turn
are
not
dealing
with.
They
are
far
more
affected
by
the
provincial
proposal
regarding
regionalization
and
creating
new
public
health
entities.
That
is
not
top
of
mind
for
us,
however,
we
do
see
opportunities
and
we
are
taking
advantage
of
opportunities
to
collaborate
with
other
local
public
health
agencies
and
practitioners
to
address
what's
been
put
forth
by
our
provincial
colleagues.
H
So
we
will
report
back
in
September,
as
I
mentioned
earlier,
with
options
for
the
board's
consideration.
They
will
go
through
the
board
of
health
budget
committee
then
subsequently,
as
through
the
standard
process,
come
here
to
the
Board
of
Health
and
then
will
be
entered
through
the
regular
city's
budget
process,
which
I
just
described
to
you
earlier.
H
A
Before
we
move
into
questions,
we
have
had
a
member
of
the
public
who
arrived.
We
had.
We
had
moved
inside
with
a
request
to
depute
I'm
gonna
I'm
gonna
suggest,
given
that
somebody
has
come
down
with
a
request
to
depute
that
we
move
out
of
this
closed
session
to
open
it
up
for
deputations.
If
that's
all
right
members
of
committee,
okay,
so
we
have
just
Mark
Harris.
A
C
Yes,
a
working
construction
as
a
sharpshooter,
local
tourism
union
and
there's
a
lot
of
bad
work
going
on
in
TCC
homes,
with
asbestos
and
insulation
and
in
my
neighborhood
in
this
building
have
about
four
babies
that
is
10
years
old
and
any
building
that
is
over
50
years
old
has
asbestos
in
it,
plus
after
50
years
old
build-up
fungus.
So.
A
Mark
I'm
afraid
I
don't
mean
to
interrupt,
but
the
item
we're
dealing
with
here
that
you're
defeating
on
is
the
Board
of
Health
budget
submission.
So,
if
you'd
like
to
keep
your
comments
to
the
board
of
health
budget,
we'd
be
happy
to
have
a
conversation.
If
it's,
if
you
have
comments
not
related
to
the
time.
C
C
That's
all
I
have
to
see,
but
you'll
be
saving
chemicals
in
treating
them
the
sewage
from
the
drinking
water.
If
you
take
the
sewage
out
is
less
chemicals
use.
Thank
you.
Another
thing,
too,
am
you're
doing
a
good
job
with
cleaning
up
the
buildings
with
the
garbage,
but
you
guys
should
come
around
more
often
with
spray
cans
to
spray
these
bins
or
please
the
superintendent's
can
do
it.
Okay,.
A
C
A
H
C
About
6
million
Oh
6
million
dollars.
Okay,
thank
you
through
the
chair.
You
know
the
the
product,
the
province,
low-income
seniors,
dental
program.
They
have
allocated
approximately
fifteen
point.
Five
million
funding
for
Toronto
for
the
year
2019
to
2020.
Has
this
program
kicked
off
yet?
Do
you
have
an
idea
whether
this
program
has
kicked
off
a
not
so.
H
Through
the
chair,
no,
it
has
not,
and
in
fact,
as
I
mentioned
in
the
presentation,
we
are
still
awaiting
details
in
respect
of
what's
included,
so
what
services
are
included
in
the
program,
so
the
the
there
are
hoping
to
get.
My
understanding
is
is
that
the
intent
of
the
provincial
government
is
to
launch
the
program
late
summer,
early
fall
so.
H
C
H
Through
the
chair,
yes
for
now,
but
again
we
have
the
opportunity
again
pending
what
the
specifics
are
of
the
provincial,
low-income
seniors
dental
program
to
then
move
costs
over
such
that
they're
covered
by
the
provincial
basket
of
funding,
which
then
liberate
s--
dollars
that
would
have
been
assigned
to
the
city's
program
to
other
public
health
programs.
That
was
the
point
that
I
was
trying
to
get
at
in
respect
of
the
financial
strategy
to
reduce
or
one
of
the
strategies.
Excuse
me
to
reduce
pressures
on
our
current
budget,
so.
C
H
Through
the
chair,
I
think
it's
a
possibility.
It
would
be
helpful
to
understand
the
specifics.
There
are
many
conversations
that
are
happening
right
now
between
our
staff
that
oversee
our
dental
and
oral
health
programs
and
with
our
the
provincial
counterparts,
who
are
establishing
the
provincial,
low-income
seniors
dental
program,
we're
hopeful
that
we'll
be
able
to
manage
some
of
it.
How
much
will
will
depend
it's
always
as
they
say,
the
devil
is
in
the
details.
Okay,.
C
I
guess
them.
Thank
you
very
much
and
I
guess
my
last
question
would
be
do
you
have
an
idea
of
the
as
to
the
timeline
of
this
Toronto
technical
table
that
they're
gonna
form
and
any
idea
when
this
is
gonna?
You
know
when
we
can.
Actually
this
tables
can
be
formed
so
that
we
can
deliver
all
our
comments
to
them.
So.
H
H
C
H
H
That's
through
the
chair,
that's
still
under
negotiation
with
the
expectation
is
that
we
will
bring
some
members
from
Toronto
Public
Health
in
the
city
and
that
the
province
would
bring
their
own
members
to
the
table,
but
we're
going
to
try
to
keep
it
fairly
well,
circumscribed,
as
the
timelines
are
tight.
Okay,.
D
So
yeah
you
can
turn
to
it
so,
while
they're
finding
it
I,
just
want
to
make
sure
I'm
understanding
the
math
on
the
first
one,
where
you
say
the
19
million,
if
the
Providence
caps
the
funding
at
170
and
then
you
go
on
and
it
says
it,
and
this
and
the
city
increases
his
contribution
to
public
health.
So
I
just
want
to
be
clear:
that's
20
million!
So
if
the
city
puts
in
an
additional
20
million,
you
hit
your
170
cop
and
then
you
still
have
a
19
shortfall.
H
H
Okay,
so
this
is
the
slide
that
actually
indicates
that
the
2020
financial
pressure
ranges
from
19
million
to
70
million
for
2020,
so
it's
at
19
million
if
the
province
caps,
the
total
funding
envelope
at
170
million
dollars,
starting
April,
1st
2020
and
the
city
increases
its
contribution
to
public
health
to
maximize
170
million
provincial
cap
so
I'm,
just
because
we're
still
working
on
getting
this.
We.
D
D
D
D
Okay
and
then,
as
you're
sitting
down
and
going
through
this
and
thinking
about
this
pressure
and
how
to
deal
with
it
like
how
do
you
have
your
program
sprang?
Do
you
have
your
programs
ranked
in
terms
of
you
know,
must-haves
nice
to
have,
you
know,
contribute,
but
like
do
you
know
like
what
absolutely
must
be
protected
versus
what
we
might
be
able
to
find
other
funding
sources
for,
for
example,
or
could
offset
delay,
etc.
D
H
Through
the
chair,
they
threw
out
the
Ontario
public
health
standards
and
its
associated
protocols.
The
language
varies
from
different
from
from
a
section
to
section.
There
are
some
areas
that
suggest
that
we
must.
There
are
some
areas
that
suggest
that
we
should
ensure
or
shall
ensure
so
there
it
does
vary
from
service
to
service.
H
That
was
the
point
that
I
was
trying
to
get
at
where
there
are
service
levels
of
expectations
that
are
sometimes
extremely
granular
and
well
delineated
and
others
that
offer
a
little
more
latitude
in
conversation
with
our
provincial
partners
at
the
Ministry
of
Health.
They
changed
the
Ontario
public
health
standards
in
2018
and,
what's
interesting
about
that,
is
that
their
document
actually
speaks
to
the
foundational
standards
as
being
the
most
fundamental.
These
are
the
ones
that
actually
speak
about
population,
health
assessment,
understanding,
the
needs
of
the
population
and
then
applying
evidence.
H
The
best
available
evidence
in
order
to
address
the
public
health
needs
it's
interesting,
because
at
the
end
of
the
day
there
is
a
uniform
set
of
Ontario
public
health
standards
and
protocols,
that's
actually
prescribed
for
the
entire
province,
but
in
fact
we
know
the
circumstances.
In
Toronto
are
going
to
be
quite
different
from
that
in
Ottawa
or
London
or
Thunder
Bay,
or
you
know
you
can
think
of
the
many
other
municipalities
throughout
the
province.
H
So
you
know
I,
think
that
that's
where
we're
interested
in
having
serious
conversation
at
the
City
of
Toronto,
Public,
Health
Technical
table
to
try
to
see
how
much
latitude
were
able
to
get,
and
specifically
you
know,
have
our
provincial
counterparts
appreciate
and
understand
what
makes
sense
for
Toronto
what
actually
addresses
the
public
health
needs
of
Torontonians.
How
that
might
differ
relative
to
what's
important
and
what
addresses
the
needs
of
populations
elsewhere
and
how
we
can
actually
come
up
with
something
and
live
within
our
financial
means,
whatever
those
turned
out
to
be
in.
D
Terms
of
the
the
strategies
or
in
preparing
and
I
realize,
there's
a
lot
of
uncertainty.
We
don't
know
exactly
what
the
cut
will
be,
but
we're
pretty
sure
there'll
be
something.
Is
there
strategies
to
engage
with
both
the
federal
government,
but
also
like
private
sector
to
look
at
like
corporate
donate,
like
are
the
programs
that
might
be
very
amenable
to
like
corporate
sponsorships,
for
example,
and
and
are
we
laying
that
out,
for
you
know
Plan,
B
or
Plan
C,
so
that
we
can
ensure
that
we're
still
delivering
these
programs
so.
H
Through
the
chair,
we
have
some
opportunities
to
engage
with
the
federal
government,
but
would
say
that
largely,
as
is
the
case
with
most
programs
within
the
Ministry
of
Health,
they
are
under
the
purview
of
the
province.
So
there
are
some
opportunities.
I
spoke
to
you
of
one
at
a
very
high
level.
There
are
certain
programs
that
are
downloaded
from
the
feds
to
the
province
and
in
turn
to
us,
tuberculosis
screening
would
be
a
classic
example
of
that.
H
Is
there
an
opportunity
to
engage
with
our
provincial
counterparts
and
our
federal
counterparts
to
see
about
a
change
in
the
funding
model
or
a
support
model
to
better
allow
for
that
service
to
continue
I
think
we
do
have
that
opportunity
so
certainly
open
to
that.
I
would
also
suggest
to
you
that
we
do
have
conversations
with
the
Toronto
office
for
partnerships
around.
You
know
what
opportunities
exist
to
engage
the
private
sector.
H
It,
of
course,
has
a
number
of
pitfalls
associated
with
it
that
we
would
have
to
address
very
carefully,
but
certainly
we
are
looking
at
what
I
provided.
You
is
a
high-level
summary
of
strategies
that
were
looking
at.
It
is
by
no
means
a
exhaustive
list
of
all
the
strategies,
in
fact,
we're
still
working
our
way
through
what
other
opportunities
might
exist
to
address
the
pressures,
because
they
are
significant,
whether
it's
on
the
low
end
of
that
range
or
the
high
end.
These
are
big.
These
are
you
know,
there's
significant
numbers.
I
H
The
chair
once
I
know
I
will
be
sure
to
let
the
Board
of
Health
know.
We
are
relative
because
we're
one
of
the
agency's
boards
and
commissions
we
actually
haven't
engaged
in
the
process.
Yet
I
understand
that
we
are
on
the
docket,
but
the
other
city
divisions
are
up
first,
so
I
will
give
you
my
best
understanding
of
what
I
believe
the
process
to
be
I
understand
that
there
are
external
consultants
that
have
been
brought
on
board
by
the
city.
H
I
It's
an
opportunity
for
them
to
pay
KPMG
again.
Okay,
all
right
now,
I
understand
what
that
is:
I'm,
not
so
worried
anymore.
Have
you
received
a
typically
by
this
point
in
the
budget
process?
There's
either
been
a
council
direction
or
a
city
manager
direction
that
goes
out
to
all
divisions
and
agencies
laying
out
the
budgetary
goals.
I
know
that
council
hasn't
done.
One
and
I've
not
been
made
aware
of
anything
from
the
city
manager.
I
C
I
I
When,
when
you
were
reading
through
this
slide
in
the
narrative
you
said
or
when
you
were
talking,
you
said
something
about
attrition
as
being
a
discretionary
expenditure
control,
but
it
doesn't
appear
here
so
does
that
mean
that
we're
currently
employing
not
backfilling
vacant
positions
through
attrition
as
a
cost
containment
method?
So.
H
Through
the
chair,
it
depends
on
what
the
circumstances
are.
There
are
certain
programs
where
we
simply
can't.
We
cannot
provide
the
service
and
meet
our
obligations
without
refilling.
There
are
other
positions
where
we're
able
to
stretch
and
still
cover
our
obligations
without
necessarily
filling
the
positions
in
the
immediate
term
and.
I
My
understanding-
and
this
is
from
years
of
experience
of
being
on
the
Board
of
Health-
is
that
it
is
not
within
your
authority
to
reduce
the
compliment
that
was
approved
by
Toronto,
City
Council,
and
this
board
without
direction
from
us.
You
can
do
it
on
an
emergency
basis
between
meetings.
Are
you
bringing
to
us
a
request
to
implement
a
strategy
to
reduce
the
compliment
that
council
and
this
board
funded
you
for
so.
H
Through
the
chair,
your
understanding
of
compliment
is
from
what
I
have
gathered.
I
did
a
little
bit
of
work
into
this
I
understand
that
that
is
not
the
case.
Our
obligation
is
towards
providing
meeting
the
needs
of
the
population.
Sometimes
that
includes
very
specific
service
level
obligations.
So,
for
example,
if
we
have
a
program
that
has
traditionally
been
provided
for
by
a
certain
number
of
full-time
equivalents
and
we're
able
to
introduce
a
technology
that
allows
for
greater
efficiency,
we
may
still
then
be
able
to
write.
I
H
I
When
Toronto
City
Council
approves
its
budget,
mm-hmm
approves
a
net
number
a
gross
number
and
a
compliment
number
and
directs
that
you
implement
the
services
based
on
that.
Every
other
division
agency,
board
or
commission
that
wants
to
change
that
partway
through
the
air
brings
something
through
the
City
of
Toronto
Budget
Committee,
requesting
a
variance
Meteor
variance.
Is
it
your
intention
to
bring
a
mid-year
variance
to
change
the
spending
or
the
complement
that
was
approved
by
Toronto
City
Council
and
the
Board
of
Health?
I
H
Through
the
chair,
it's
you
know
if
I
can
on
this
notion
of
how
much
we
have
approved
in
terms
of
compliment
and
how
much
we
actually
have
on
board
at
any
one
given
time
I'm
just
going
to
look
at
my
numbers,
because
I
don't
want
to
misspeak
and
I,
will
ask
my
Director
of
Finance
and
Administration
to
correct
me.
Should
I
misspeak,
but
my
understanding
is.
For
example,
we
have
a
staffing,
an
approved
staffing,
complement
of
approximately
1800,
1850
and
I.
Don't
know
the
exact
number
I,
don't
know
Alethea.
H
If
you
have
the
exact
number
available
to
you,
but
at
any
point
in
the
year
we
have
an
average
that
looks
more
like
about
1,750
staff,
FTE
complement
on
hand.
So
while
there
is
a
specific
number
that's
approved
as
part
of
the
budget
process,
in
fact
and
I,
don't
think
this
is
unique
to
Toronto
Public
Health.
H
The
actual
number
that
are
available
on
hand
may
and
will
differ
from
the
technically
approved,
compliment
the
obligation
as
I
understand
it
is
to
meet
the
service
level
and
to
meet
the
needs
and
obligations
that
we
set
out
as
part
of
the
budget.
So
there
is
latitude
with
respect
to
managing
the
FTE
and
the
complement
if
we
are
to
significantly
make
changes
in
respect
of
a
program
area
which
then
has
specific
complement
implications.
Given
that
we
are
a
75%,
staffing
and
benefit
type
organization.
Clearly,
we
would
bring
that
forward
to
this
table.
H
However,
changes
that
are
around
changes
that
allow
us
to
meet
certain
financial
pressures,
but
still
allow
us
to
meet
the
obligations
to
the
population
as
I
understand,
do
not
meet.
We
may
come
and
inform
you,
but
they
do
not
necessarily
require
the
approval
of
the
board.
That's
my
understanding
of
how
the
process
works,
but
be
very
happy
to
discuss
further
for.
G
H
Through
the
chair,
just
to
be
clear,
do
you
mean
in
existing
municipal
funded?
So
no,
there
are
other
jurisdictions.
I
know,
for
example,
that
just
to
the
west
of
us,
Peel
Region
has
one
I
believe
Halton
may
also
have
one
but
I
off
the
top
of
my
head.
I
can't
remember
all
the
different
jurisdictions
that
currently
have
a
lowest
low
income
seniors,
but
not
all
of
them,
not
all
of
them.
That
is
correct.
Okay,
thank
you.
A
Other
questions
I
have
some
before
I'll
open
it
up
for
a
second
around.
If
there's
a
request,
any
other
questions.
Okay,
so
I
just
went
through
the
for
all
of
our
benefits.
The
Board
of
Health
Budget
Committee
is
meeting
in
September
and
then
will
be
bringing
a
recommendation
to
this
board
when
which
which
meeting?
Is
it
that
this
board
will
next
consider
the
budget.
H
A
H
Through
you,
mr.
chair
I,
I
think
the
the
budget
process
for
the
2020
budget
process
is
definitely
different.
This
year,
director
perks
brings
up
a
a
important
point
in
his
comments.
I've
got
I,
don't
have
the
exact
dates,
but
my
sense
is
that,
in
order
to
meet
the
timelines,
it
will
likely
either
be
the
October
or
the
November
meetings.
Okay,.
A
H
A
Is
the
current
expectation,
because
some
of
the
uncertainty
related
to
our
provincial
share
is
the
current
expectation
that,
at
that
October
board
of
health
meeting
is
when
we
will
be
asked
to
endorse
a
final
budget
to
present
to
city
managers?
That's
a
current
working
plan
that
may
change
based
on
the
province.
A
In
October
or
November
is
when
this
board
will
be
making
a
final,
okay,
the
Board
of
Health,
Budget
Committee,
and
so
in
the
supplementary
report
that
members
of
this
board
will
have
received
on
Friday.
Our
Board
of
Health
Budget
Committee
made
some
recommendations
that
this
board
will
then
be
asked
to
endorse.
I
will
have
a
motion
to
that
effect,
which
was
directing
or
requesting
you
dr.
A
A
There
was
also
a
request-
and
you
alluded
to
it
in
your
one
of
your
last
slides
around
conversations
with
other
medical
officers
of
health
and
the
association
of
public
health
agencies.
There
was
also
a
request
from
the
Board
of
Health
Budget
Committee,
for
an
update
on
the
status
of
conversations
you
are
having,
with
other
medical
officers
of
health
related
to
an
alternative
provincial
restructuring
proposal.
Do
we
have
an
update
on
that.
H
So
through
your
mr.
chair
I
can
provide
you
a
high
level
update
at
this
stage
of
the
game.
We
are,
as
I
said,
I've
been
actively
engaging
with
members
of,
for
example,
the
association
of
local
public
health
agencies
and
with
the
members
of
the
Council
of
medical
officers
of
health
of
Ontario.
We
are
working
through
some
processes
and
trying
to
propose
a
model
that
we
can
put
forward
to
the
chief
medical
officer
of
health
and
that
he
in
turn
can
share
with
the
Minister
of
Health
and
others
within
the
provincial
government.
A
I
Can't
take
it
just
call
me
Gord,
so
I
want
to
understand
this
a
little
bit
more
clearly,
I
meant
to
go
and
get
the
the
actual
council
direction,
but
I
didn't
have
time
to
find
it.
My
my
understanding
of
the
practice
has
always
been
that,
yes,
we
do
have
gapping,
because
people
leave
jobs
and
you
need
to
move
people
around
and
so
on,
but
any
decision
to
reduce
the
staffing
in
a
program
area
for
any
reason
on
a
permanent
basis
requires
direction
from
this
board.
Is
that
your
understanding,
through.
H
The
chair,
that
is,
you,
know
again
if
it's
a
significant
reduction.
Yes,
however,
my
understanding
is
that
certain
latitude
is
given
to
particular
smaller
reductions
that
effectively
allow
us
to
continue
to
deliver
the
service
and
to
meet
our
obligations
that
those
do
not
necessarily
require
approval.
They
would
be
as
long
as
we're
following
appropriate
HR
policy,
labor
relation
policy,
labor
law
and
we're
delivering
on
the
service
meeting
the
obligation
that
that
would
be
something
that
we
could.
H
I
So
so
this
this
process
of
attrition
that
you've
described
is
not
Board
of
Health
wide,
not
trying
to
Public
Health
wide
you're,
not
doing
it.
For
so
this
conversation
grew
out
of
a
statement
you
made
about
responses
to
date,
holding
on
discretionary
experiment
expenditures.
Have
you
mentioned
attrition
as
one
of
the
ways
that
you're
doing
that
you
have
not
implemented
attrition
or
not
back
filling
vacant
positions?
H
H
I
spoke
about,
ensuring
that
we
meet
the
obligations
to
the
board
and
that
the
board
has
under
the
health
protection
and
promotion
act
and
I
also
spoke
about
the
role
and
responsibilities
that
we
share
in
respect
of
seeing
within
the
existing
financial
envelope
and
ensuring
that
we're
executing
or
using
the
resources
responsibly
and
appropriately.
So
in
so
doing,
we
may
have
attrition
that
comes
up
retirements.
We
do
have.
H
We
will
have
to
make
the
decision,
as
we
would
as
responsible
custodians
of
the
dollars
to
determine
what
is
the
best
way
to
make
sure
that
we
protect
public
health,
that
we
achieve
our
objectives,
that
we
meet
our
service
obligation
within
the
existing
resource
envelope.
So
is
it
across
Toronto,
Public
Health?
It
depends
on
where
the,
where
the
vacancies
pop
up
and
if
we,
if
it's
in
an
area
that
requires
an
individual
to
provide
a
specific
service,
we
will
try
to
do
so
within
the
existing
resources.
I
So
I
I
need
to
draw
a
further
distinction,
then
so
there's
a
difference
between
gapping,
which
is
managing
temporary
vacancies
where
someone
may
retire
or
be
on
a
mat,
leave
or
have
left
their
job.
For
other
reasons,
and
taking
some
time
and
refill
it
and
filling
that
back
that
period
is
the
gap.
There's
a
difference
between
that
and
the
administration,
not
the
board,
taking
a
decision
that
unless
there
is
some
compelling
reason,
we
will
never
backfill
positions
I'm
trying
to
understand
what
you
are,
what
the
administration
of
Public
Health
is
actually
doing
at
this
time.
H
H
What
we're
trying
to
do
is
make
sure
that
we
meet
the
obligations
that
we
have
set
ourselves
up
for
that
we
have
that
we're
able
to
discharge
our
obligations
under
the
Ontario,
Public
Health
standards
and
it's
protocols,
so
that
you
in
turn
is
the
Board
of
Health
can
assure
yourselves
that
you
have
discharged
your
responsibilities
under
the
health
protection
and
promotion
act.
What
that
means
is
that
if
we
have
vacancies
available
or
vacancies
come
up,
we
are
actually
as
a
senior
team.
Looking
through
what
service
does
it
provide?
H
Do
we
have
the
means
by
which
to
do
it?
Does
it
require
refilling
either
from
an
internal
using
existing
resources,
or
we
in
a
position
where
we
have
to
go
externally
we're
doing
all
of
these
things.
Frankly,
on
a
case-by-case
basis,
because
we
feel
that
we
have
to
given
our
current
financial
pressures,
we
will
not
be
able
to
meet
the
financial
pressures
if
we
don't
consistently
and
regularly.
A
C
C
C
I
I
And,
of
course,
whenever
that
happened,
the
cost
the
city
was
going
up
and
we
had
no
idea
where
the
bottom
was
you'd
open
your
newspaper
every
day
or
I
guess
to
go
on
the
internet
to
get
you
and
you'd
find
it
that
somewhere
else
in
the
world,
another
Bank
had
failed
and
we
had
no
idea
where
the
bottom
was.
So.
The
city
manager
at
the
time
distributed
a
memo
and
saying
that
he
was
implementing
hiring
freeze
across
the
corporation
and
he
had
directed
agencies
boards
and
commissions
to
follow
that.
I
It
then
was
put
forward
to
Council
where
we
endorsed
it,
and
we
knew
that
that
would
have
service
level
impacts
and
in
the
process
of
doing
that,
we
sort
of
red
circled
an
amount
of
money
and
certain
kinds
of
work
that
in
that
time
of
crisis,
we
knew
we're
not
going
to
be
touched.
We
made
sure
that
the
most
vulnerable
in
our
society
weren't
the
ones
losing
services
as
a
result
of
that
hiring
freeze,
it
was
painful
and
difficult
process.
We
had
to
do
it
on
a
dime,
but
it
was
collaborative.
I
It
was
collegial
and
both
the
elected
government
and
the
public
service
and
the
public
service
leadership,
all
the
players
and
the
unions
all
understood.
What
was
going
on
I
understand
that,
while
nowhere
near
is
severe,
we
are
facing
a
certain
kind
of
problem
because
of
the
absolute
uncertainty
about
provincial
funding,
I'm
tempted
to
call
it
the
provincial
clown
car,
where
you
don't
know
from
day
to
day
what
funding
is
available
for
the
operation
of
our
service
and
I?
Get
that
that's
a
problem.
I
I
also
get
that
there
was
a
live
conversation
taking
place
prior
to
the
premier,
walking
back
his
decision
to
arbitrarily
cut
public
health
funding
retroactively
Lee
there
was
a
live
conversation
about
the
City
of
Toronto
backfilling
that
funding
it
was
openly
talked
about.
Several
mayor's
across
the
province
of
Ontario
said
that
they
would
do
that
in
the
event
that
the
province
did
not
step
up.
I
So
there
is
a
willingness
to
at
least
have
the
conversation
that
if
there
is
a
shortfall
in
Toronto,
Public
Health,
that
is
not
allowing
Toronto
Toronto
nians
to
receive
the
services
that
this
board
and
Toronto
City
Council
committed
to
delivering
whether
or
not
the
City
of
Toronto
would
step
in
there's
a
willingness
to
have
that
conversation.
I
am
concerned
from
what
I've
heard
today
and
it
wasn't
prevent
presented.
In
writing.
I
It
was
an
offhand
comment
during
offhand
verbal
comment
during
a
presentation
that
we
are
not
filling
the
positions
of
people
in
public
health
and,
as
the
medical
officer
of
Health
has
repeatedly
said
to
us,
the
overwhelming
majority
of
cost
to
deliver
those
services
is
people
so
where
we
lose
people,
we
lose
the
ability
to
deliver
those
services.
I.
I
I
It
was
not
in
the
written
presentation
and
I'm
deeply
concerned
at
what
we
have
is
not
adequate
I'm,
hoping
that
the
chair
in
his
wisdom,
because
he's
closer
to
these
things
than
I
am,
can
make
some
kind
of
a
recommendation
on
how
we
as
a
board,
should
direct
the
medical
officer
of
Health
to
make
sure
that
the
Public
Health
Service
is
that
we
want
that
the
city
wants
and
very
clearly
from
the
reaction
of
the
provinces,
threatened
cuts.
We
know
Torontonians
one
is
not
threatened
by
a
cost
containment
exercise
which
we
have
not
directed.
E
Just
just
briefly
point
out,
because
this
makes
me
this
is
this
budget
in
particular,
it
makes
me
really
nervous
right
when
you
start
talking
about
modernizing
in
healthcare
and
with
with
a
limited
amount
of
resources.
We
know
what
that
means.
I
counsel,
a
commissioner.
What
a
director
whatever
counts!
The
Gord
mentioned
that
the
this
is.
This
budget
is
predominantly
a
staff
cost
budget.
E
That's
it's
the
same
for
a
lot
of
budgets,
a
lot
of
forward
facing
a
social
service
budget
and
at
the
City
of
Toronto,
and
just
by
using
a
magic
eraser
and
taking
off
taking
money
out
of
the
budget
and
saying
that
you're
doing
in
the
name
of
modernizing
doesn't
necessarily
result
in
better
services
for
for
people
and
this
language
of
modernizing
isn't
new
I
just
looked
up
the
2019
budget.
Bri
analyst
knows
it
was
all
in
there
modernizing,
transforming
innovating.
This
wasn't
put
on
us
by
the
province.
E
This
is
work
that
we
constantly
do
and
as
it's
work
that
we're
constantly
doing
we're
constantly
generating
savings.
The
bait
I
it
said
in
the
same
budget
analyst
notice
the
base
budget
that
staff
brought
back
to
to
City
Council
from
public
health
was
lower
than
the
previous
year.
The
base
budget
found
savings.
We
were
already
reducing
the
budget.
The
budget
increased
because
of
a
new
and
enhanced
funding
that
came
from
Council
and
from
council
direction.
So
these
service
increases
are
what
drove
the
budget
over.
So
we
were
finding
efficiencies.
E
So,
let's
not
not
think
now,
all
of
a
sudden
that
the
province
is
in
that
we're
all
of
a
sudden
gonna
get
enormous
ly
better
at
this.
Of
course,
we'll
find
some
savings,
but
we're
not
gonna
get
to
hundreds
or
directly
to
20
million
30
million
dollars
in
savings.
I'd
also
point
out
too,
to
get
to
Commissioner
the
director
lies
comment.
We
do
already
rely
on
private
sector
money
for
our
our
student
nutrition
program
if
we
continually
as
a
government
in
general,
but
as
this
particular
body
as
this
board
start
to
say.
E
E
We've
lost
major
festivals
because
of
this
in
the
City
of
Toronto,
because
they've
decided
to
put
their
money
into
other
things,
and
we
have
no
say
absolutely
no
say
so.
Let's
this,
this
is
one
of
the
areas
where,
like
fixing
roads
is
one
thing
you
can
add
a
year
on,
you
can
like
it
doesn't
get
any
better
worse
service,
but
these
are
people's
lives
that
are
in
the
mix
in
this
one,
and
so
we
cannot.
A
That
I'll
speak
to
a
specific
direction,
which
is
to
not
implement
a
hiring
freeze
and
year.
If
such
a
proposal
is
made,
I
would
like
it
to
be
brought
here
that
is
above
and
beyond
gapping
in
the
normal
course.
So
let
me
begin
first
of
all
by
thanking
staff
in
Toronto
Public
Health.
It
has
been
a.
It
has
been
a
very
challenging
number
of
months
for
our
staff,
as
well
as
members
of
our
Board
of
Health
Budget
Committee
in
this
and
this
board.
It
is
not
often
in
my
five
years
very
brief.
A
The
future
is
somewhat
uncertain
for
the
following
reasons:
one
this
this
board
this
city
in
this
province.
We
won
the
the
reversal
of
the
retroactive
cut,
so
we
did
win
that,
but
the
future
is
unknown
and
the
future
is
unknown,
because
the
Premier's
office
have
told
us
that
there
is
a
reset
and
they
want
to
work
with
us
to
come
up
with
a
new
funding
model
for
the
future.
A
The
chief
medical
officer
of
Health
says
that
he
has
not
been
formally
communicated
those
directions,
and
thus
it's
simply
a
deferral,
and
so
we're
stuck
in
we're
stuck
in
limbo,
with
the
provincial
government
trying
to
figure
out
who's
in
charge
and
what
the
direction
is
and
to
my
concern
here
is
that
without
proactive
work,
we
will
sleepwalk
back
into
the
previous
model
proposed
of
cuts
with
the
principle
being
that
the
best
opposition
is
proposition.
The
recommendation
here,
which
is
one
see
that
dr.
Davila
spoke
to,
is
for
us,
as
the
Board
of
Health
for
dr.
A
Davila.
Is
our
medical
officer
valve,
in
collaboration
with
other
medical
officers
of
health,
with
the
association
of
public
health
agencies
and
others,
is
to
put
forward
an
alternative
restructuring
proposal?
I
think
there's
wide
recognition
that
there
five
public
health
units
in
the
province
is
not
the
exact
right
number
of
units
that's
yet
to
meet.
Anyone
who
thinks
that
thirty
five
is
accurate.
Should
it
be
twenty-eight?
Should
it
be
25?
A
We
don't
know
I've
yet
to
speak
to
anybody
in
the
prowl
in
the
public
health
food
community
who
doesn't
believe
that
there
are
some
services
that
could
be
centralized
across
public
health
units,
and
so
there
is
a
restructuring
model
that
is
focused
on
the
effective
delivery
of
Public
Health
Services,
as
opposed
to
simply
cost-cutting
as
an
overarching
objective,
but
a
model
which
would
reduce
costs.
It
would
just
maintain
population,
health
and
so
I
think
that
one
C
is
critical
and
we'll
talk
about
that.
A
But
in
the
fall
we're
gonna
spend
a
lot
of
time
in
the
budget,
because
in
the
fall
we
will
either
be
asking.
We
will
either
be
coming
to
this
board,
asking
perhaps
to
endorse
an
alternative
model
and
going
to
work
to
sell
it.
We
may
also,
in
addition
to
that,
be
asking
this
board
to
continue.
Consider
savings
that
don't
impact
the
health
status
looking
at
revenue
options.
All
that
is
to
say,
is
in
this
fall.
We
will
have
to
be
ready
for
any
outcome.
A
We're
not
gonna
sit
back,
but
we
will
be
ready
for
any
outcome
and
we
will
ensure
that
the
health
status
of
Torontonians
remains
our
first
and
foremost
our
priority,
and
we
won't
let
cost-cutting
our
revenue
options
getting
in
the
way
of
that.
With
that
I'll
conclude
my
remarks,
questions
of
the
mover
yep.
D
Thank
You
chair
Cressy
for
one
seed.
Yes,
what
you
see
is
a
formal
mechanism
to
submit
this
through,
like
is
there
a
public
consultation
process?
Would
this
be
done
through
your
being
in
the
committee
that
you're
setting
up
like
how
would
this
be
transmitted
to
the
provincial
government
and
dealt
with.
A
So,
as
were
into
questions
of
me,
I'll
respond
and
and
I'll
let
dr.
Davila
afterwards
come
over
in
chat
as
necessary.
So
currently
conversations
are
happening
amongst
medical
officers
of
health
amongst
chairs
of
boards
of
health
around
a
potential
alternative
model,
one
that
would
be
ideally
brought
to
boards
to
consider,
as
well
as
to
alpha
the
association
of
public
health
agencies
and
thus
shared
with
the
province
providing
a
better
option.
A
So
that
would
an
update
on
the
development
of
that
and
the
potential
consideration
our
ask
of
this
board
to
consider
it
would
be
coming
this
fall.
So
that's
the
format
in
which
those
conversations
are
taking
may
yet.
These
technical
tables
we
haven't
had
a
meeting.
Yet,
in
fact,
I
can
tell
you
that,
in
the
suggestion,
in
the
request
for
the
city
to
participate
in
a
technical
table
with
the
province,
it
was
explicitly
stated
that
political
representatives
were
not
invited
and
so
I
don't
have.
A
lot
of
I
am
cautious
of
these
technical
tables,
but
dr.
D
If
they
have
identified
that
this
is
a
position,
that's
no
longer
needed
because
there's
been
some
sort
of
modernization
and-
and
they
are,
you
know
through
attrition-
it's
not
different
than
what
you're
saying
here
was
the
entire
increased,
because
I
think
in
the
comments
that
we
heard
from
the
chief
medical
officer
like
she
was
stating
that
she
felt
that
there'd
been
no
reduction
in
service
and
that
they've
been
able
to
manage
that
within.
So
how
does
this
relate
to
what
we
heard
her
speak
to
previously,
so.
A
If
there
is
I
want
to
just
have
it
very
clear
from
the
Board
of
Health
that
and
in
your
hiring
freeze,
if
that
is
brought
forward,
that's
something
that
we
will
talk
about.
But
that
is
not
the
direction
from
this
board.
We
have
a
frequent
process
of
assessing
gapping
and
looking
at
how
we
can
continue
to
deliver
service
as
there's
gapping,
but
there
has
been
no
request
to
implement
and
in
your
hiring,
freeze
and
I
want
to
make
sure
that
that's
the
direction
from
this
board.
D
D
A
Anybody
else
to
speak
all
right,
all
budget,
all
the
time
this
year
at
the
Board
of
Health.
So
we
haven't.
We
have
a
motion
on
the
table,
all
those
in
favor
opposed
if
any
okay,
that
carries.
Is
there
an
item
as
amended
on
this?
No
because
it
was
just
the
presentations
all
right,
I,
believe
that
brings
this
meeting
to
a
close
have
a
great
summer
for
those
who
are
getting
away
and
we'll
see
you
all
in
the
fall,
if
not
sooner,.