Transcript - Board Urges Supervised Site Funding - Board of Health

attack your audio. Good morning everybody. Happy Monday. It's not quite April yet, but we're almost there. Springlike weathers today. I think it's a high of 19 today eventually. Uh my name is Chris Moyes and I'm the chair of the board of health. The clerk hasn't confirmed that we have quorum. So I'll call meeting 31 of the board of health to order. And again, welcome to those in the room and online. Today's meeting is being held by video conference and in person at city hall in committee room number one. Because we are meeting in person and remotely, we ask everyone for their patience with any delays and technical issues. If you are registered to speak at today's meeting, please listen for me to call your name. I will call speakers in the order they appear on the list. The list of speakers can be viewed online by visiting the board of health page at toronto.ca/counsel and click in the speakers box for today's meeting. The clerk has provided all agenda materials on toronto.chil and via cmp the clerk's meeting portal. Directors, please ensure that your video is turned on. Please keep your mic muted unless you wish to question staff or to speak on an item. As part of each agenda item, I will ask directors to raise their hand or mute their mic if they wish to question staff or to speak. I will then create a speaker list and will call on directors when it is their turn to speak. When voting on an item or motion, I ask the directors raise their hand to indicate their vote. Directors, I want to remind you that you must submit your and approve your motion by email. Staff are available at uh b torontoronto.ca to help with motions. The board of health acknowledges that the land we're meeting on is the traditional territories of many nations including the Missagas of the Credit, the Anoshabbec, the Chipoa and the Hodoni and the Wendat people and is now home to many diverse First Nations, Inuit and Matei peoples. We also acknowledge that Toron is covered by Treaty 13 with Missagas of the credit. The city of Toronto acknowledges all treated peoples including those who came here as settlers as migrants either in this generation or in generations past and those of us who came here involuntarily particularly those brought to these lands as the a result of the transatlantic slave trade and slavery. We pay tribute to those ancestors of African origin and descent. Are there any declarations of interest on the mutual conflict interest act? If you have an interest, please raise your hand or unmute your mic and indicate the item number and the nature of the interest. Seeing none in the room or online. Next, we need a motion to confirm the minutes from our last board of health meeting on February 23rd, 2026. Uh, Director Chandra Balon. All those in favor? Those carried. Thank you. Uh, so again, good morning everybody. Um, please join me in welcoming our newest board uh of health directors, Rebecca uh Mador and Chara Gourd. Did I pronounce that correctly? Okay, good. It's good stuff. Uh Rebecca Mador is a matei citizen and the director of strategy and planning at Shaka Shakab Makqua Makqua that um an indigenousled center for first nations inuit and matei wellness innovation of the center for addictions and mental health. Her work focuses on health system planning, policy development, and building cross- sector partnerships to improve population health outcomes. Uh Sha Gord is a lifelong public health practitioner, educator, and advocate. She began her work at Toronto Public Health as a healthiest baby's possible dietician and eventually became the acting project coordinator of the Toronto Food Policy Council. She was also associate program director and lecturer in the University of Toronto Masters of Public Health Community Nutrition Program of the Delana School of Public Health. So, thank you Rebecca and Chara for joining us uh at the board of health. Round of applause everybody. Shauna is online with us and uh Rebecca is in the room with us. So, we are very happy to have you and I'm sure that uh your experience and expertise will shine as we continue this work together. As you may know, on March 26th, the AIDS Committee of Toronto closed its doors after serving communities impacting impacted by HIV AIDS for over 40 years. What started as a small grassroot organization in the 80s helped lay the groundwork for health care and policy landscape in which eliminating HIV AIDS is within reach. They truly understood the people they served and what it meant to meet them where they were. ACT reached clients in what might seem an unlikely place to those outside of the community bathous. For years, their team of dedicated volunteers assembled safe sex kits for distribution of the bathous in the village. I know that for many of the volunteers, the regular sessions provided a strong sense of community. This is the legacy that ACT leaves behind, one rooted in community advocacy and resilience. I would like to extend my sincere gratitude to the ACT team, past and present, for the unwavering dedication to supporting people impacted by AIDS. Now, on to to today's agenda. Our first presentation this morning is uh from Dr. Murdy herself, the 2025 year in review of Toronto Public Health. I know that Dr. Murray really wanted to highlight the work TPH does every day to protect people from health risk and prevent illness before it starts through immunization inspection, sexual health services, health uh school health, food safety, health aging programs, and more. I'm looking forward to hearing more about these ongoing efforts and as well as some of our achievements from last year. Following the year in review, we'll have a presentation on our action to advance indigenous health. At the core of this work are the principles of co- leadership and self-determination. Through the presentation, we'll learn more about how these are reflected in our actions. For example, the recent change to the way we allocate funding from the Toronto Indigenous Health Fund to the Toronto Aboriginal Support Services Council for distribution to indigenous service providers removing TPH as the intermediary. So, thank you Mon'nique for your for joining us to share updates on this work today. Our third and final presentation is on the health impacts of the homelessness and and will include an update on the downtown core program. I've been closely involved in the implementation of the core team since the beginning as their catchment falls in Toronto center and receive I receive regular updates on their progress. I'm always amazed to hear about not only the volume of clients interactions they handle, but also the meaningful impact they're making through sustained contact with the clients they serve. Recently, they were able to secure housing for nine people, including four to be housed at our heart hub, supportive housing in Toronto Center. I really do believe in this model for outreach and I'm happy to support the recommendations to extend the pilot another 18 months as the informal evaluation continues. And finally, on a much more solemn note, the province has doubled down on their shift away from harm reduction and overdose prevention by choosing to defund remaining safe consumption sites that receive provincial funding in Toronto. This will impact the SCS at Fred Victor as well as the Moss Park consumption and treatment services, leaving only the Kensington Market overdose prevention site and street health to serve the entire city. We've heard loud and clear from existing SCS and other community organizations that they have been overwhelmed since the first wave of closures. I've also heard from residents who have noticed a significant increase in public drug use. I can only imagine that losing more sites will compound these negative impacts. I'm also very concerned about the impacts further closures will have on our ability to collect information about the unregulated drug supply through Toronto drug checking services. The trends we see in fatal and non-fatal overdoses are largely due to what is in the drug supply. If we lose sight of what is in the drug be people are using, we will be illquipped to respond to overdoses. Nlloxxone is undoubtedly one of the most effective tools we have to reverse overdoses. But it does not reverse the effects of veterary tranquilizers which are showing up in over 80% of fentinol samples. We wouldn't know this without Toronto's drug checking services. This is just one example of why we must ensure drug checking samples collection sites remain available. This board has historically been steadfast in his support for the life-saving and life-changing services provided by safe consumption sites. Beyond just the safe consumption sites, these sites offer breath of services and supports that include low barrier primary care, housing referrals, and mental health treatment. Today I am bringing forth a motion that in addition to requesting the province continue funding SCS, ask that if funding for safe consumption sites is cut, sites receive funding to continue providing these additional services for the clients they have fostered trusting relationships with. I am also com commending that we add our voice to the public call for continued funding for SCS by signing the letter from the Canadian Drug Policy Coalition Drug Strategy Network of Ontario and HIV Legal Network urging province to reconsider the decision to defund provinially funded supervised consumption sites in Ontario. I'll speak to the motion further when it's is considered, but for now, I'd like to pass the floor to my new vice chair, uh, Director Chandra Balon, to share a few words. Go ahead, I'm truly honored to serve as the vice chair for Toronto Board of Health. I've had the privilege to be appointed to this board just over three years ago, and I'm proud of the progress we've made together. During this time, we've completed the recruitment of our medical officer of health um and launched our first pre postcoid, sorry, not pre-postcoid strategic plan work that I've both personally supported through the hiring committee and the implementation panel. I want to sincerely thank you, Chair Moyes, the outgoing vice chair, councelor Bravo, and my fellow board members, but especially the dedicated staff at Toronto Public Health. Your expertise, your commitment, and ongoing support is what makes this work possible. and meaningful. I look forward to continuing to uh serve on this board in this new role and continue to build on our progress as we make Toronto a better place to live, work, and play. Thank you. Thank you, Vice Chair Tendra Balon. Uh now turn over to Dr. Marty for her remarks. Thank you, Chair Moyes and Vice Chair Tendra Balon. Good morning, everyone. It's nice to see you all here on this bright spring morning. Uh before we begin, I'd also like to extend my greetings to our two new board members. A very warm welcome to Chara Gourd and Rebecca Mador. On behalf of Toronto Public Health, we look forward to working collaboratively with you, drawing on your diverse perspectives, shared expertise to address the evolving public health needs of our community. As we turn our attention towards today's agenda, I want to highlight a few pieces from our staff reports. First, we'll be presenting Toronto Public Health's year in review for 2025. This report is just a snapshot of the diverse and impactful work that Toronto Public Health does every single day. As part of my requirement to submit an annual report, this report aims to highlight the range of activities that we do to protect, promote, and improve health. It also speaks to how we collaborate with partners, advance health equity, and use innovation to improve our services. You will see that the impressive statistics we present in this report were also achieved on a background of growing population, increasing demand for our services, and increasing complexity of the services we deliver. We're also highlighting today that our work with equity deserving communities has been an integral focus of our work. in our actions to advance indigenous health report. And in today's presentation, you will learn more about how Toronto Public Health is working with and within indigenous communities to guide and co-develop an indigenous wellness action plan for the city, strengthen our relationships with indigenous service providers, and advance indigenous health data sovereignty. Today we will also focus on the health impacts of homelessness and receive an update on the downtown community outreach response engagement or core program. We will be highlighting the range of actions and activities that Toronto Public Health leads along with partners to protect and promote the health of the people who are underhoused and homeless in the city. This includes programs like the downtown core pilot with our Toronto Police Services and their outreach in the downtown east community. I'd also like to acknowledge from Toronto Police Services uh the individuals who are here today and the collaboration that is having a positive impact in this community. The work we're doing with Toronto Trentians who are at the intersection of homelessness, mental health challenges, and substance use continues to remain as important as ever. Since June of 2025, we have seen a reversal of the previous downward trends in non-fatal and fatal overdose calls to emergency services in the city. And with rising call volumes starting since June of 2025, this has more marketkedly increased since October of 2025 and is continuing to rise in 2026. This more recent change has been coinciding with an increasing frequency of tranquilizers detected in the drug supply where now as councelor Moyes mentioned over 80% of drug samples that were thought to be fentinyl are contaminated with metatomdine an animal tranquilizer that is not approved for human use. The presence of tranquilizers means the effect of an overdose can last for several hours. And the effects of tranquilizers, unlike opioids, cannot be reversed with nlloxxone. These changing trends are just one more reason of why we remain committed to responding to the acute drug toxity toxicity crisis. foundational programs, monitoring, surveillance, reporting, public alerts, nlloxxone training, and drug checking services remain critical tools in our response to the rise in both opioid and non-opioid overdoses. These actions remain vital in our community when considering the provincial government's recent decision to end their funding for consumption and treatment services, including two sites in Toronto. Toronto Public Health and our community partners remain committed to supporting evidence-based approaches that improve health outcomes, save lives, reduce the spread of infectious diseases, and connect people to vital social and health services, including treatment, pathways to housing, and recovery. Finally, before I turn it back over to Chair Moyes, I want to recognize the work of Toronto Public Health's communications team, some of whom are in the room today. Our public health communications team plans and manages strategic communications, media relations, and the call center for Toronto Public Health. They play a critical role in ensuring that public health matters receive appropriate attention, understanding, and accurate information dissemination for Torononians. I'm pleased to announce that this team has been named a finalist for the strategic communication team of the year category at the 2026 strategic global awards. This awards program highlights outstanding achievements by communication professionals who are shaping the future of the field worldwide. Award recipients will be announced next month and we are all keeping our fingers crossed for a winning results for our team. Finally, I'd like to say thank you to the entire Toronto Public Health team for your compassion and the commitment that you provide year round. I'm proud to have this forum to appreciate and commend the contributions of everyone at Toronto Public to you. Back to Chair Moyes. Thank you. Thank you, Dr. Murdy. And thank you to all our public health um staff do amazing work each and every day. Um so we'll move on to we have two new business items to add here. So the first one is a letter from the clerks for the new appointments to the board of health. Two members. You want to post it online on the screen? Thank you. Okay, I will move this item to be added to the agenda. All those in favor? Those carried. Thank you. And the second item is the letter I referenced earlier in my remarks. If you want to post that as well. I will move that all those in favor. Those carried. Wonderful. Uh okay. So we'll do the rundown. So the first item is HL 31.1 2025 a year in review of Toronto Public Health. Uh there are speakers in the presentation on this item. So I will hold it down. Item two, actions on advanced indigenous health. Uh there's a presentation that item as well. And there is a speaker, so I'll hold that down. Item three, uh health impacts of homelessness and update on the downtown core pilot. Uh there's also a presentation on this item and there are speakers as well, so I'll hold that down. Um item 31.4, Toronto Public Health operating budget for the year ending on December 31st, 2025. Anybody wants to move that? Uh, councelor Bravo. All those in favor? Post carried. T31.5 Toronto Public Health Capital Budget for the year ending on December 31st, 2025. Uh, Director Mador, you want to move that? You want to move that item? Say yes. All those in favor carried. Uh item six, city approved Toronto Public Health 2026 operating budget. Um Director Gore, you want to move that item? Yes. All those in favor? Those carried. Uh T31.7 city approved Toronto Public Health 2026 capital budget and 2027 to 2035 capital plan. Uh Director Zh with that item. All those in favor? Post carried. T 31. TE. I don't know where I'm at now today. It's HL 31.8. Too many committees I sit on. Uh 2025 performance appraisal medical office of health. Anybody want to speak to the item? Oh, we have a speaker on this item. Okay. So, we'll hold it down. Uh 31.9 reopening item HL30.1 and HL30.2 2 and HL 30.3 to correct appointments ending date. I will reopen that. All those in favor? Those carried. You want to post a new item? Okay. So, just adopt as a Okay, we're going to adopt the recommendations as a whole. All those in favor? Those carried. Okay. Um, can I do 10? the whole uh HL 31.10 new appointments of the board of health. Uh I'll move that item. All those in favor? Those carry. And there is one speaker on the new item which is HL 31.11 finish off the funding of consumption and treatment services. So I will hold that down. Okay. So we can go back to the top of the agenda and uh I'm going to turn to Dr. Murray to speak to this item. 25 year in review of Toronto Public Health. Thank you, Jay. So, we'll have the next slide. So, good morning and I'm very proud to be presenting to you today on our 2025 annual report. The 2025 year review report represents a snapshot of Toronto public health accomplishments in 2025 to highlight a range of everyday activities as well as special achievements. I want to acknowledge that this is only a small portion of the work that TPH staff do every day. As the largest public health unit in the largest municipality in Canada, TPH helps more than three million people stay healthy and build a safe place to live, work, play, and study. As Toronto's population grows, so does the demand for public health services. We also recognize that people are facing a number of challenges to their health and well-being due to climate change, emerging infectious disease threats, the spread of miss and disinformation, and a rising cost of living. Despite these pressures, in 2025, Toronto Public Health prioritized evidence-informed interventions, responded to health threats, and strengthen collaboration and partnerships in the community. Slide. Public health is part of everyday life in Toronto, even when you don't see it. Every day, Toronto Public Health protects people from health risks and prevents illness before it starts through things like immunizations. inspections, school health, food safety, and healthy aging programs, and more. In 2025, we inspected more than 27,000 of your favorite restaurants and places to eat. We also provided education to event organizers for more than a thousand major citywide events, making sure that residents and visitors can enjoy markets, festivals, and carnivals safely. Toronto Public Health also inspects businesses like nail and hair salons and tattoo parlors. In the last 10 years, we've seen a nearly 20% increase in these settings, which has put and as well as an increasing complexity in services that has put pressure on our inspectors who inspected more than 2,000 settings last year. The work of public health also extends to schools, keeping children and youth healthy across the city and helping them get access to nutritious food and school. In 2025, we provided school health services to more than 350,000 students across 815 schools and we had the largest expansion of the student nutrition program that we've seen since 1998. Toronto Public Health also helps reduce the transmission of infectious diseases throughout our city. In 2025, we completed more than 1,200 investigations of vaccinereventable diseases, infections such as measles, mumps, and ptasus, which is approximately double the prepandemic average of 611. providing case and contact management reduces transmission risk and protects residents across the city. These investigations are increasingly complex as Toronto Public Health has seen an increase in the number of clients experiencing homelessness, individuals without access to primary care, and newcomers navigating the health care system. We also responded to 318 active tuberculosis cases, an increase of nearly 25% in the last 10 years, providing critical case management and prevention efforts that help provide supports for people infected with TB and reduce transmission risk, including in settings such as shelters and schools. In 2025, we also managed the local impact of two provincewide shortages of rabies vaccine that require timely modification to guidance to health professionals to ensure that individuals with potential exposures to rabies were adequately protected. These shortages were compounded by a 28% increase in rabies exposure assessments compared to the year before. TPH plays an important role in responding to emerging population health concerns. In 2025, we responded to the largest Ontario measles outbreak in more than 25 years with case and contact management, health promotion messaging, and vaccination through TPH programs and public education campaigns, helping limit the transmission and protect residents. Efforts to respond and maintain vaccine coverage resulted in only 10 measles cases locally in Toronto compared to the over 2,000 cases proincially and only two of those cases were linked to the larger provincial outbreak. In response to record-breaking heat events in the summer, we worked with partners to continue increasing the number of cool spaces to more than 550 publicly available locations, monitoring heat related illness, and continuing to develop heat vulnerability mapping to identify communities most at risk. In 2025, Toronto Public Health supported the response for four Northern First Nation communities that were evacuated to Toronto due to wildfires. This included a number of our services such as immunization, dental screenings, harm reduction, breastfeeding, and parenting supports. We also had our indigenous health team on site supporting the facilitation of communication and culturally safe care. Finally, our team responded to 475 media requests on topics such as respiratory illness, measles, extreme weather, and rabies throughout the year, helping residents make informed decisions to keep themselves and their loved ones safe. Toronto Public Health collaborates with other city divisions, hospitals, clinics, pharmacies, and community partners to develop and implement public policy and programs that enhance the health of individuals, communities, and the entire city. Working within the continuum of health care and within community agencies helps ensure residents are more connected to services and care reaches those who need it most. Some highlights include that in 2025 we our one of our largest accomplishments was the establishment of the downtown Toronto homelessness and addiction recovery treatment or heartthub. Toronto Public Health worked with the Ontario Ministry of Health, Ontario Health, city divisions and health and community partners to propose, establish and execute funding for the heart hub which is providing substance use care and housing. We also increased access to breastfeeding services through expanded hours and the opening of two new breastfeeding clinics in partnership with Humber River Hospital and Ancestral Hands, increasing access to care and increasing parent knowledge and skills to support successful breastfeeding and equity deserving communities to support pregnant people and new parents. We also expanded access to in-person support groups through the perinatal adjustment program in partnership with South Riverdale Community Health Center and Match Midwives. Finally, in 2025, we relaunched the Your Health Matters partnership with Toronto Public Library, offering people recommended resources on nutrition, sexual health, physical health, and mental health. Easily accessible to residents in their own local library. The collaboration is a focused collection of adult and teen books available at 19 branches across the city aimed at supporting physical and mental health reinforcing Toronto Public Health as a trusted source of health information. Another important role of Toronto Public Health is monitoring health trends, using evidence to guide decisions, and advocating for policies that keep people safe. In 2025, I provided witness testimony to the Senate Standing Committee on Social Affairs, Science, and Technology in support of Bill S202, which would require warning labels on alcoholic beverages about risks such as fatal cancers. Our team also submitted recommendations to Health Canada's third legislative review of the Tobacco and Vaping Products Act, emphasizing the importance of enhanced enforcement and compliance restrictions in online sales, advertising, and retail availability. Finally, we regularly support our city divisional colleagues with evidence and advice on a number of topics including but not limited to indoor temperature, noise, safet, the health of seniors, and suicide prevention. As public health experiences ongoing growth in both demand for and complexity of services, we need to find ways to innovate and modernize the way we work to continue to meet our mandate. Some examples of innovation in 2025 include transitioning our DSafe system to Salesforce, replacing the outdated system which will streamline food safety inspections and investigations, launching an online system for Toronto doctors, nurses, and hospital pharmacists to order publicly funded medications for the treatment of sexually transmitted infections. Reducing administrative workload for staff as we've been seeing an increase in both STI rates and orders for medications in Toronto. enhancing our technology to manage tuberculosis cases without an increase in case managers. This includes an immigration medical surveillance tool to streamline medical reporting for those entering Canada and required to complete an immigration medical exam. Finally, piloting new tools on a small scale, such as electronic consent that lets parents consent to vaccine clinics without having to fill out, track, and process paper-based forms for routine immunizations in schools. At Toronto Public Health, we strive to create a healthy city for all. We do this by responding to threats to health, meeting community public health needs, complying with the Ontario public health standards, and evolving to meet the needs of a growing city. Together, our efforts promote health, reduce gaps between communities, strengthen emergency readiness, help people stay healthy, and build a safe place to live. I'm proud of the dedication of all staff to deliver these critical programs and services each year. Thank you. Thank you, Dr. Murdy. Uh we do have speakers on this item. Um up first is Daniel Fryheit. He's usually online. Daniel, are you there? My timer is working properly. Daniel, can you unmute yourself? We'll get back to him. Let's try Gil Panovosa. Is he there? No. Uh Brooke Coatsworth. Oh, there we go. How's it going? Oh, looks like it's uh wrong video there. See if that helps. Uh, great. Thank you. Thanks for your patience. Um, I had sent in a presentation. I'm not sure if Sorry, Daniel. Go ahead. Go ahead. Hi there. I'm not sure if my presentation was able to get through to the the secretary for uh public for viewing. Was are you able to confirm if that was received or can be displayed? One moment. You could you're able to share your your presentation, Daniel. Okay, great. I'll do that. There it is. Okay, there. Yeah. So, just by way of an introduction to the new members of the board. First of all, welcome. I'm the uh you can call me the Jiminy Cricut of the Toronto Board of Health. I uh at one point applied uh but uh now I'm just kind of an outside adviser consider myself. So this what I'm showing here I just wanted to speak to uh the one of the so I do a lot of advocacy on X by the way uh about you know um talk about this misinformation and disinformation words that were used by the way in this report without really explaining what it is what it was and how the board plans on tackling it. So I kind of do this in my own way by just kind of always going to my authorities and source documents. What you're showing here, what I wanted to bring to the board's attention here is um part of the vaccine injury uh reporting mechanism that the board of health had used during COVID. Um this is an individual who had contacted me. Oh, did it go away? Yeah, there it is. Um so what you're seeing here and I just want to bring this to the board's attention. Um, this is an adverse event document, a reporting document that Toronto Board of Health Public Health had used during COVID. The left side, these are these documents should be the same, but they're not. They're actually, and I highlighted it on the right, um, the difference between these two documents. Um, this is a document of an adverse event following immunization. One copy on the left was sent to the patient. The other copy on the right was sent to the patient's doctor. And the reason why this is important is because what this shows is that um an a a an adverse event investigator within Toronto Public Health was sending um misleading or different versions of the same document and kind of representing that they were the same. In one case on the left, the the investigator tells the patient that the uh the adverse event was caused by um was likely caused by the vaccine. on the right it says it was possibly psychological reaction and that version was sent to the patient's doctor and so when we talk about misinformation and disinformation I need to the board needs to re-evaluate their own um kind of do a retroactive evaluation as part of its future planning for addressing misinformation what we're seeing here is that in this case it resulted in the patient having delayed medical treatment because the doctor who got this contradictory or got this a misleading report um ended up not properly treating the patient. Toronto Public Health during COVID and even now it still acts basically as a as a as a patient's physician like even though it's not really supposed to it effectively does so it has to be really careful and and do a proper investigation to what happened here with these adverse event reports and this the investigator in particular. Um how's my time by the way? Where am I? I don't even see my time anymore. Uh you have two minutes left. Okay, I'll be fast because I see there's other speakers too. But so if you so basically and I uh you know councelor Peruza uh at one point you know I talked about a cover up in one of my previous delegations. Maybe that language is a bit harsh but but something like this is you know it it's pretty close to uh you know um to something of that nature when you have uh these uh investigation reports that are misleading patients as to what has been sent to their own physicians. It took this particular patient almost two years to discover this. Um as as you scroll down, what I tried to do through an access to information act request is find out how common this was like what what was the practice here of um you know sending uh of the adverse event reporting mechanism. Um and and was it was was there selfcorrection going on within Toronto Public Health to to fix this problem? whether it was just a rogue uh investigator or whether it was a practice to send different versions of adverse events to the patient and different versions to the to their to their physician. Um and I was um roadblocked on this request because I was told here um so I asked for whether there were any changes to the uh internal uh adverse event reporting procedures uh in response to identified or alleged mis mismanagement. So maybe I could narrow that down and just say what was the adverse event um review protocol because I think this was an example of uh I'll call it insidious misinformation because it was done behind the back of the patient. Um but you can see in that in that uh response the the uh the city or the the board refused to provide uh any response to that request because it was considered meetings consultations. Um so you know I could fight this information request. It'll probably take me four years to get make any progress. 10 seconds Daniel. Yeah. So, if the board wants to, you know, take any steps to address this as part of its misinformation disinformation campaign, that would be amazing. Okay. Thank you. Any questions for the deputent? Seeing none. Thank you. Uh, is Gil Panol here? No, still not here. Um, Brooke Coatsworth online. Brooke. Can you hear me? I can see you. Um, unmute your mic, please. Can see your name, Brook Coatsworth. Yes. Good morning. Here we go. Okay, five minutes. Go ahead. Thank you very much. Go ahead. I'd like to start this year in review by reflecting and remembering that every word spoken in this chamber, every light bulb and every salary paid, including those city councilors, is funded almost entirely by the hard work and earnings of taxpayers and property owners. Nearly all of the city's $18.9 billion budget, comes directly from them. We acknowledge that while taxpayers and property owners have endured an almost 20% increase in the last 3 years, only a small and insulated group decides how much of their income is expropriated to sustain a burgeoning municipal bureaucracy that continues to grow regardless of outcomes and results. We pay respect to those taxpayers because without them, this institution could not indulge. Focus on perhaps the item in front of you. I'm not quite sure you're talking. I I am counselor. Thank you very much. Um you're in review for Toronto Public Health. Yes. And I would like to acknowledge the taxpayers that have supported the the year that you guys are reviewing. Thank you. In the spirit of acknowledgement and councelor Mory's urgency uh and with an eye to the future, we recognize the Toronto taxpayer and rever their tolerance for being taxed. Yes, I am here to speak to HL 31.1, a year in review. Uh year in review speaks to your progress as we move forward into the new year. I have to say uh after a few TPH board meetings last year, it's great to see so many counselors in the chamber today uh to make it out for the first TPH board meeting under the new year and and new and and former chair. Uh also great to see that the meeting only started four minutes late today. Pretty good. Uh Toronto Board of Health oversees public health policy and programs for the city. Over the past 40 years, it has led several impactful initiatives including the expansion of smoke-free bylaws. It strengthens school immunization enforcement programs, the introduction of dying safe system, and many other programs that are measurable, sustainable, and that have contributed to the improvements in population health across Toronto. Now, your focus on infectious disease, the drug toxicity crisis, cost of living pressures, climate risk, and misinformation, all wicked and complex problems. As you move forward, I want to first remind you that public trust is shaped by what people see and experience. Since councelor Moyes took office took the chair role, sorry, in 2022, TPH has reset its strategy with a heavy focus on community-based and equitydriven approaches. This is a focus on h on how public health operates, not just what it delivers. As you move forward under the same leadership, I must remind you uh the TPH board that there is considerable evidence that councelor Moyes does not operate in the public's interest and has a political activist motivations. For example, having a public board member from a professional lobby and political strategy group as his new vice chair raises an eyebrow. For all those board members still listening, keep in mind that the Toronto, sorry, the citizens of Toronto are paying more attention uh than we were in 2022. Thank you very much. Okay, any questions for this deputent? Seeing none, thank you for your time today. Up next is NORAD UID. Not here. NORAD, not here. Okay, Arnold Mark Willis online. Arnold, I see your name on the screen. Unmute yourself, Arnold. Can you hear me, Arnold? Okay, we'll come back to Arnold. Uh, Daniel Tate, are you here? Okay, five five minutes. Good morning. I'd like to quickly start with the civility acknowledgement. As we gather in this hollowed civic institution, we remind ourselves to speak with care and to refrain from derogatory or hurtful remarks. The prestigious office of local government and the people it serves demands the highest standard of conduct and we reaffirm our commitment as political leaders to engage with constituents in an honorable and respectful manner. Can you speak to the item in front? Now on to the year in review for Toronto Public Health. Um much want to remind this room and everybody watching that the budget for this division is $37 million in fiscal 2026 with $13 million allocated for harm reduction activities. Just to do a recap of some 2025 statistics. Uh in 2025, Toronto Public Health distributed 1,799,272 needles, many used for intravenous fentinyl injection. 426943 smoking pipes used for the inhalation of fentinel and crystal meth and 579,668 crack pipes for crack smoking. Many in the community wonder if we'll break the 2 million mark for needles in 2026. I guess we'll have to stay tuned to find out. Now, obviously, the chair and the medical officer are ecstatic about these numbers as evidenced during their budget meeting in which both discussed the need to add harm reduction distribution capacity. Now, on the topic of harm reduction, with um all these harm reduction supplies that have been distributed, I think it would be very wise to show these supplies in action on the streets of Toronto. Here we see this individual using their cityissued meth pipe uh enjoying his pastime of meth smoking on the TTC. Uh, another individual with their city issued crackpipe smoking it also in the TTC in full view of citizens and their children. Uh, here we have somebody in the throws of fentinel addiction on a GO train. Um, very likely they use cityissued supplies as well. Here we have uh the city issued harm reduction kits strewn on the ground in Yorkville about 30 m or so from a public playground. We can see tourniquets, needles, uh, etc. And then finally, we have another individual in the throws of crystal meth addiction participating, uh, in this activity on the subway in full view of um, subway passengers uh, also using his cityissued taxpayer funded pipe. So, everybody in this room calls what I've just displayed harm reduction. Um but a very large majority of citizens of Toronto call it harm production. Now with regards to the annual report from the med medical officer of health, I noticed a few omissions and I'd like to speak on those quickly. Uh the first is the decline of olfactory health. What is olfactory health? Well, it's the nose. It's what we smell. And right now a lot of people say the city stinks. uh take a a walk on the streets of Toronto. You will smell disgusting trash uh fumes emanating from our garbage bins that are busted. You'll smell the remnants of public defecation uh and even sewage uh in some places. Why is there no discussion of olfactory health? Because we know that is uh uh an important thing for public health. Uh the scourge of public defecation is real and there's no mention of it also in this annual report. What is Toronto Public Health doing to mitigate the scourge of public defecation? I just came back from Spain and they have a wonderful network of public bathrooms. Their streets are spotless. Why do we not have that here? Also, the word detox or rehab appear exactly zero times in this report. Why? Lastly, the words mental health are also missing from this report. And when we're talking about the impacts of mental health, we're not just talking about the mental health of drug abusers, but we're also talking about the mental health of law-abiding regular citizens and their children who have to witness the behaviors of these drug abusers. What about their mental health? In summary, this report leaves a lot to be desired. There are severe pressing issues that seem to have been glossed over and taxpayers are wondering if we're getting value for our $37 million. Thank you. Okay. Any questions for this deput? Seeing none. Thank you. Uh Nicole Cora. Nicole here. Welcome Nicole. Nicole. Okay, let's go to Marico Uda or Udy. Sorry, Nicole. Nicole's there. Nicole, can you hear me? Yes, I can hear you. Finally, I I I able to start my to I'm able to to start to to unmute. I couldn't We can hear you now. Go ahead. You have five minutes. Go ahead. Yeah. Okay. So, a couple of things. Um a few things. I think that it's very obvious that from this report that animal health is connected to human health. A rabies vaccine shortage is not an excuse to kill and dissect animals. The solution is obvious. More rabies vaccines and better humane testing. While antimmortem test is only currently allowed for humans in Canada, the vaccines can be used without testing the animals as a precaution. Uh Nicole, Nicole, we're talking about uh the year review for public health, not about animal testing. So, can you please try and stay on topic? Yes, this is part of the topic. What I was saying is that is regard to the um the the rabies exposures. It says testing brain tissue needlessly kills orphan kills orphans and mutilates animals. Many animals who bite are mothers and it also causes dangerous false negatives. If the animal who bit only had rabies in their saliva but not their brain yet, then a brain test would come back a false negative. There are fortunately point of care tests like the dine immune rapid rabies test by Dr. Michael Hutchel that that can test say even can swab a bite saliva from a bite because you can tell which animal from DNA testing which animal bit a person from a a swab of a bite. You could test rabies the same way and and I think the city of Toronto needs to look into that. The other thing, safe dining is also a human animal coexistence issue. A lot of food waste attracts rodents, raccoons, coyotes, bears, etc. But the poison bait and glue traps are both cruel and attract a lot more animals, weak weakening them and making them prone to disease. Please ban cruel methods of rodent control and work with rodenticidefree Ontario, an organization dedicated to to uh ending uh glue traps, poisons, and other lethal forms of rodent and wildlife management. A nutrition program is best served as a pl as plant-based. Animal agriculture is a breeding ground for zunotic illness, diabetes, heart conditions, etc. Humans are designed to eat plants. It's better for humans, animals, and the planet. All universal nutrition programs need to be vegan because that's that's a you know a universally designed anybody can everybody can eat vegan food and uh yeah so I think I think more looking at human and animal health as one health and looking at but not looking at the animals as vermin or as things to eat or as a health threat but looking at humans and animals as neighbors as part of the same family. Looking at it holistically and ecologically that that that does tie into the um this item because these these issues are in in this item. If you look very closely, I think tax dollars, you know, other people were saying we have to be thinking about how our tax dollars are being used. The most efficient way to use the tax dollars is to use the is to look at things ecologically to, you know, instead of just putting money into harm reduction, actually put money into the root causes of the addictions. Look at why are these people being addicted? Well, maybe they they they don't have proper housing. There's they they they don't know, you know, when their next meal is coming. So, all that anxiety is is keeping their addiction going. But if you got rid of the you got rid of the root cause of the addiction, you would end up getting rid of the addiction altogether. So looking at how animals are getting into waste bins, you know, one prior deputent said that animals are getting into waste bins. Well, if you secured the bins, say with bear bins, bear boxes, the uh animals would not be getting into the bins and then you wouldn't have these these bite incidents. You know, if you got rid of the the poison bait boxes that are used for rodenticide, which attract other animals, you would uh you would have less bite incident. So that that's you know looking at keeping the animals healthy, keeping the environment healthy and providing healthy vegan plant-based food for people. And final thoughts uh you're almost at time. Final thought is look at everything holistically and from an ecological Thank you very much. Thank you. Any questions for deputent? Seeing none. Thank you. Arnold Mark Marilis. Yeah, here we go. I could see you. Just unmute yourself. Arnold, do you hear me? Yeah, we can hear you now. Go ahead. Five minutes. Excellent. Um, now uh during this year we heard a lot of presentations at this board talking about indoor air quality. Not much was said today by the way but I wanted to amend the presentation. So uh some landlords surprisingly not only schools but also uh the rental housing uh they use uh intentionally uh pollute indoor air quality in order to speed up tenants turning around in the building or if it's a public housing to receive renovation funds from the city. This is true and uh my attempts uh for example in my unit this is exactly the case. I don't want to name my landlord but uh uh uh not only in my unit but also in the building hallways uh through the ventilation system the air is regularly at night intentionally polluted and uh some uh land uh landlord cronies are uh approached to also contaminate air from their unit contaminate air in the hallways. So obviously I discuss it with public health several times and uh unfortunately their attitude and their equipment is inadequate to address uh this particular problem. Uh for example uh they regularly came uh or periodically came to my unit with 3 to four 5 hour late uh bas uh compared to previous arrangement. They don't have night shift where uh the landlord usually undertakes this activity and uh the equipment like uh portable uh air quality meters inadequate uh for example they don't measure TV total volatile organic compounds in the air and the landlord namely contaminates using volatile organic compounds such as insecticides highly potent poisons and uh very strong uh industrial cleaners and similar things. So and instead they practically show me like presence of uh the uh particular matter in the air which is totally irrelevant to this particular measurements. So basically trying to fool the uh the complainant or city resident. So uh the reports also don't refer to particular regulations uh of Canada or Ontario and they don't refer to particular equipment model intentionally uh because uh the equipment as I said is inadequate. The other thing is that uh the low training uh level of the um inspectors who are coming and even the managers of particular areas or or particular areas of the city they are not familiar with building design HVAC equipment design and they don't know how to for example they don't understand explanations of tenants like myself I a professional how exactly landlord in intent potentially contaminates the building through uh ventilation system and through other systems. So the other thing is that uh the uh province has equipment loan uh equipment loan program and in particular they can easily loan for free for example um uh volatile organic compounds meters or some tubes to collect overnight and then use the mass spectrometer to uh have the spectre of contaminants present. they don't know about it despite the medical officer of health came understand from the province. So the other thing is that uh access to entire labs they also have access that they don't use and uh for example behavior of some staff like associate directors uh apparently they are kind of assigned for life like Mrs. uh Anna Miranda shut down voicemail, shut down telephone, never respond to uh emails. So she doesn't exist and it's not even clear where she sits. Impossible to make an appointment. Now night shift is mandatory at least one public health inspector at night to ensure indoor air quality in uh public places and in uh residential buildings. Now it's none. After 4 p.m. they never come. And this is totally inappropriate. I'm asking the board of hills first the associate director should report every six months to the board of health the accomplishments. Second establish your time. Your time thank you for your deputation. Any questions for deputent? I see none. Thank you. And last on my list is uh Marico U. Did I pronounce that properly? Is it UDA or UDA? UDA. Okay. Yeah. Thanks. Five minutes. Go ahead. Okay. Um, good morning. Um, so in the Toronto Public Health 2025 year in review, it does mention immunization, but there were just two bullets and I would have liked to seen a bit more detail on the status of COVID 19 um vaccine administration. I think it's significant to include this in the report. Um, when I go to the Toronto Public website, a public health website, it says that COVID vaccines are available now for everyone 6 months of age and older and that TPH is hosting community clinics for young children 6 months to four year olds by appointment. I'm interested to know if that actually happened. Um, if so, I'm surprised because according to the National Advisory Committee on Immunization, which Toronto Public Health um follows, they do not strongly recommend vaccinations for 6 months to four year olds. They use the word may, not should. And that's it's just one word but it's so important because um it and it's confusing because Nassie has two kinds of recommendations. One is a strong recommendation and in that case they use the word should and then the other recommendation is a discretionary recommendation and they use the word may. And a discretionary recommendation really in my mind should not be called a recommendation because um well I'll read you the definition of a discretionary re recommendation. Um Nassie says known or anticipated advantages are closely balanced with known anticipated disadvantages or the uncertainty in the evidence of advantages and disadvantages exists. So, it's very um it's not very um it's not a confident recommendation at all. And I think that I think they shouldn't call it a recommendation. Um but they do. And then that's why I think it gets misunderstood. And then um Toronto Public Health on their website says that uh infants 6 months to four years should get vaccinated once a year but I think that should be changed to May because we have to follow the national advisory committee of immunization at least like we can't go beyond unless that because we don't really have that um uh expertise or I can't think of the word like we should be following national advisory committee on immunization and I'm happy to um you know talk about it more um and and this is all very concerning because as time goes on more and more evidence is coming about out about the side effects of the COVID 19 vaccine. So why would we give it to our most vulnerable babies? Um last year um over 80 um researchers and clinicians uh penned a Canadian open letter calling for the halt to the mRNA COVID vaccines. And in other countries they are not giving it to the young and healthy. For instance, Sweden um they don't give it to anyone uh young and healthy. And as well Japan like you have to pay in Japan to get the vaccine about $100 if you're uh younger than 60 and young and healthy. So um in closing, I would like the extent of COVID vaccinations to be documented in the year in review 2025 and also that all COVID 19 mRNA vaccine recommendations be reviewed considering the concerns in this call to halt letter which can be found at www.callthe number two halt the number9.ca. Um and they highlight like five emerging concerns that we may have not known at the very start of the co 19 vaccine campaign which I think are very important to look at. Um and in particular I would like the recommendation to vaccinate infants to be um reviewed and immediately addressed for the love of our children. Thank you very much. Yeah. Thank you. Any questions for deputent? Seeing none. Thank you. Um, there is one more. I know there's one more speaker that was just added. Uh, Skylard Hill Jackson. May I have the overhead, please? Just put it on the screen. It should come up. I think this deputation is asking board members, do not believe everything you think. I understand the Toronto Board of Health 2025 year-end review is committed to making Toronto a healthy and resilient place for all by following best practice guidelines and optimizing health outcomes at all levels. I see Toronto public health literature states vaccinations keep our your children healthy. I ask why our Toronto children currently are the sickest generation. Toronto children are experiencing a major epidemic of neurological and immune system disorders requiring EpiPens, nut-free zones, and specialed teachers. Are the 75 doses of 18 vaccines recommended by Toronto Public Health really protecting our children's health? Vaccines have never been safety studied and there are no studies on the safety of combining multiple vaccines. Are there too many vaccines? In 2004, Ontario added the chickenpox vaccine and now there is a shingles issue in the older population. But no worries, there is a shingles vaccine for seniors. If you mess with nature, there will be consequences. Why is Toronto Public Health afraid of childhood natural illnesses? What happened to trusting our natural immune systems? Currently, women are choosing not to take the recommended seven plus vaccines during pregnancy. Today, educated women know that everything crosses the placenta and the bloodb brain barrier, and vaccine ingredients may damage the unborn baby's brain, just like alcohol, drugs, and smoking. These educated women know there are no safety studies to support pregnancy vaccinations. And now, parents are questioning the safety of recommended childhood vaccines. There are 30,000 Toronto District Schools, grades 2 to 5, elementary school children, who are eligible for school suspension notices. Is this because many parents are realizing the harms that vaccines may cause to their children? Pregnant women and new parents are afraid of vaccine roulette. They are afraid of vaccine roulette because apparently no one knows the real cause of autism. Maybe it is genetics. Maybe it is the improved modern autistic diagnosis methods. It basically remains a mystery. Instead of getting hysterical over 10 measel cases in Toronto in 2025, why has the Toronto Board of Health ignored the real epidemic in Ontario? As of early 2026, over 84,000 children are registered in the Ontario Autism Program and seeking services. Reports indicate over 60,000 children are waiting for care. April is World Autism Awareness Month. Our public libraries call April Autism Awareness Acceptance Month. Our uh autism is being normalized in Toronto classrooms. Autism is not normal. What is the board's plan for who will look after all these autistic children when they become adults and their parents die? Why is Toronto Board of Health ignoring the autism epidemic? Nothing in this deputation is misinformation, disinformation, or malinformation. The science is never settled. The greatest obstacle to discovery is not ignorance. It is the illusion of knowledge. Toronto Board of Health members, do not believe everything you think. Thank you. Okay. Thank you. Any questions for the deputent? Seeing none. Thank you. Okay. We'll now take it in-house. Uh any questions for staff from uh board members? Uh Dr. Zho, go ahead. Dr. self. Um so thank you um Dr. Murdy for a very comprehensive presentation and I really um like the dashboard that you have put together on keeping us updated on all of the different initiatives from providing vaccination updates to members of the public. um information about um misinformation for instance um as well as the targets around the harm reduction um and heart uh heart hub uh models as well. Um my question is more around um harm reduction leading to treatment. So I recognize that um there's been a lot of discussion on providing um harm reduction supplies um in the dashboard. Uh however, I also recognize that um the board of Toronto Public Health uh does a lot of uh work when it comes to opioid agonist therapy providing treatment to people who use substances and I was wondering if you can sort of highlight that a little bit more um for the board uh as I didn't notice it was covered very comprehensively in the uh dashboard. Uh to the chair, thank you for the question. uh you this was meant to be a snapshot. So we weren't able to fully include all of the aspects of it. We we thought we would choose a few pieces that um were not necessarily highlighted in either the strategic plan or other regular updates uh like we had at the our health our city um annual update uh that speaks a bit more wholesomely to some of the questions you have on on mental health and and harm reduction. Um, so certainly I think we we highlighted the the roll out of the heart hub as our key achievement or one of the key achievements in 2025 having to transition from the closure of our supervised consumption site to um the addiction and homelessness treatment model. Uh and so we do are you know very proud of the work that's been able to have um uh you know almost no days lost in terms of the opioid agonist therapy. So, you know, we we closed one day and the next site was open immediately the next day. So, the clients that we were seeing for treatment on opioid agonist therapy could be transitioned immediately to the new site um and have been able to continue with that um with the treatment of those clients uh through this year. We have certainly had some challenge this year with the ending of the injectable opioid agonist therapy by Health Canada by the end of 2025. Um and we have seen uh some loss of clients who preferred that method of therapy um as treatment for compared to what we were able to offer now um without without that option. Uh so we we are continuing to work with our partners. I I think you know one of the biggest things we're still transitioning in this new model is um how to have more clients aware about coming into these services. So, I I think it speaks to um what Chair Moyes spoke about in terms of the the need for some of the the the drop-in services that can really be that friendly front door for people um who are using substances who, you know, when they are ready for for treatment can be referred to treatment options. Um and and we have a less of that front door and we're losing more of those front doors with with the closure of these sites. So, I think having that ability to for people in the community who are interacting with these clients to know about our service to to make that kind of warm handover to our services when people are ready to experience treatment um is definitely something we we continue to work with all of our outreach partners on as well as the community partners, but it's certainly it's it's a challenge with more of those friendly front doors, closing their their spaces. Thank you. And I also wanted to highlight that um a lot of the people who um come to you for harm reduction are often offered um treatment primary care. Um and uh it seems like that's also a very um positive impact that Toronto Public Health is having on a lot of people who use substances as well. uh to the chair. Yes, we're absolutely, you know, I think that we'll see in the next presentation, I think some more of the the highlights of just one of our outreach programs where when we are able to interact with clients and really assess, you know, what what kinds of needs they have, provide that case management, able to link to social services and other supports. Um housing is is absolutely one of the the very common issues that people um are are identifying as as a need to address. Uh we work very closely with our Toronto sheltered services partners um as well as the other outreach team, the Toronto Crisis Communication uh center as well to make sure we're connecting and and really trying to be as uh coordinated as possible to find the right route to to housing to supportive housing that's necessary for that client. Um I think we're we're very, you know, accept welcoming of the 25 units that we have through the heart hub model. um and that we're able to now identify clients who who can um enter housing into through that pathway as well. Thank you for um uh your statement and uh I would be very interested to hear in the future um how many of those clients are moving from let's say harm reduction or being offered uh treatment and uh wraparound supports as well. Wonderful. Thank you. Uh any other questions from councelor Bravo? Go ahead. So, doc, sorry, director, you had a question. Go ahead. Five minutes. I did. Can you hear me? Yes, we can. Beautiful. First, I want to start by saying welcome to our new board members, Chara and Rebecca. Thank you for applying and we're looking forward to um working together and bringing all your expertise. And I want to say thank you to the Dr. Marty and the the staff of public health for um this wonderful report. Um my question is more on so we've done a good job 2025 but there's always rooms for improvement going forward. What were I I read through the report but I couldn't find this. I'm just curious. What were the or are there any like two or three top priorities between um the capacity that TPH has now and the need in the community? And if so, do we have any plans to address that going forward for this year? Uh to the chair, thank you for the question. Um so the goal of this this report was not necessarily to identify those um areas for improvement. We do still uh this was meant to be an adjunct and kind of a snapshot in time to our larger um updates that we do to our strategic plan. So very much uh we are still looking at fulfilling some of the outstanding areas of the 2024 to 2028 strategic plan as kind of our our continued priority areas that we're moving on um and forward onto those areas to to really keep focused as to what are those uh what are those specific you know biggest picture health issues in the city that we're trying to address. I think within the report itself, you know, we we we have really tried to highlight that we are providing these services on a backdrop of a growing population, growing demand for service and growing complexity of our services. Um I think just a couple of examples to that to really highlight within the report we've showed is that um our personal service setting inspection time has gone from 30 minutes to 55 minutes. And that's a change because of the complexity of services that people are providing in these settings. you know, we're we're going into places where we're finding non-regulated healthcare prover, you know, just people who are not healthcare providers offering Botox, offering micro needling. So very complicated investigations that our investigators have to go in, assess what's actually being provided, assess the risk of that. Is there a need for notification? And we're seeing many more of these places than we have in the past. So the volume of of settings is increasing because we know that these services are becoming more popular, but also the complexity is increasing. So, we have um you we'll we'll definitely have a ready sort of to experience an inability to get to every single site that we would like to, but we also need to look at new ways of really classifying risk and making sure we're getting to those highest risk sites to to address um potential risk within the community. Just one other example to that I think is the the complexity we have um in terms of people navigating services. So for many of the infectious diseases we have um you know it's it's very challenging to find a primary care provider to be able to actually do some of the the testing and follow-up that's necessary as part of that infectious disease out um investigation. This year we had uh earlier in 2025 and as well now towards the end of 2025 um outbreaks of chageela infection which is a diarrheal illness in the homeless population and finding the right pathways to care um for these individuals is is quite complex. And so there's not just the case and contact management public health aspect but also the the the complexity of navigating a health care system when when one's not really available for these clients. Thank you for that. And then just one quick followup. Um, uh, we had a favorable variance which we're going to see later in the agenda of well favorable net variance of about 50 million. And I'm just curious um, how should we interpret these achievements alongside the variance/underspending especially in the areas of high need? Uh, to the chair, thank you for that question. um we we had an variance because of a shift of staffing that we had. So we've had a very major um reset in terms of particularly uh a lot of our nursing staffing in terms of the the work that we were doing precoid and now adapting to the new Ontario public health standards in terms of healthy aging across the lifespan. Um we will not be seeing that same variance coming forward in 2026. We have had a number of hires coming in both at the end of 2025 and now continuing in 2026. So we are much closer to that um full staffing level that will uh bring that variance down for this year. Okay. Thank you. Thank you. Um any councelor Bravo? Thank you. Um so I have about five questions. I'll try to do this quickly. In terms of drug testing, um, in the past, we've heard from, uh, staff here that it it's not quite good enough to offer, but is this an important line of defense when, uh, drug users who may live in a, you know, be very wealthy in a nice home all the way down to somebody who's living on the street, a way to self-protect in terms of being able to test their own drugs and take agency over their own health? Uh, yes to the chair. Absolutely. We we do really rely on the drug testing program. I believe uh councelor voice has a motion to this later on in terms of the importance of this service and uh that's the only reason we know that 80% of the supply is contaminated with things like animal tranquilizers and that cuts across every like part of society every you know drug use is pretty universal. Um thanks. So the next one is around opioid treatment. Um what is available right now? What does that look like in a nutshell and do we have enough of it? uh to the chair. Um what what we're providing in um our 117 the esplanade site is largely the oral opioid agonist therapy. Um we do have some other adjunctive therapies for people um depending on the complexity of their their condition. Uh so certainly within the broader uh treatment system um I'm sure Dr. which could maybe speak to even sort of what what else is there in the broader community as well, but the um the the types of pathways to through from detox to longerterm um therapies to um you know more uh conventional um cognitive behavior therapies that go along with um uh medication based therapies. We do know still that many there's also a large private market for um addiction therapy as well that's outside of the publicly funded system. What would the kind of medication look like? What's available right now? Uh, I'm actually going to turn that over to Thank you, Dr. Patty Chaz with that one. Uh, thank you, Dr. Murdy, and uh to the chair to you, counselor Bravo. Um, so presently at our um our treatment site, it's predominantly methadone and suboxone um with a few adjunctive therapies as Dr. Marty had mentioned. Um that's great. Yeah, thank you. That's perfect. Thank you. Um in terms of the concern of the deputants about the connection between autism and vaccination um just to if you could just quickly say if there's any kind of medical evidence of that. But um a second part of that is the increase in cases of autism. Does it have anything to do with the ability now and the availability of uh testing or diagnosis I should say? Um and and there was a sort of an autism is not normal but are there could be people in this room that uh have autism and so I just wanted to to just touch on that quickly. Yes. Yes. So to the chair, I mean certainly the the link between autism and vaccines has been disproven uh very um you know there's there's lots of evidence to show that there has not been any causal effect between vaccines and autism. Autism itself is a very complex uh medical condition that that really encapsulates a range of neurogenerative um conditions and certainly there has been more of a diagnosis bias in that more people are aware of that condition getting diagnosed and and and um and diagnosed with that condition. But but it is an area of of you know we still have a lot to know more um and certainly the the range of that the the way that people are best treated by that all of the other potential reasons um that it's not just a diagnosis um increase that there there may be other reasons but I don't think we we know all of those reasons yet and are we moving more toward um kind of neurological diversity rather than divergence or uh you know away from the idea that there's a perfect normal person that doesn't have doesn't fit on any uh there's no variety of brains out here. I I think certainly from from an anti-stigma component um you know the the the more acceptance of uh neurode divergence is is something that has been part of um things we've seen with our school partners with community partners to be able to to accept um you know and have that that range of neurody divergence and and people it's not a yes no condition. So I have two more which I'll do quickly. u mental health um crisis in youth. We we do have a particular strategy around that and looking at that. Correct. Uh so certainly the youth component is captured within the our health our city mental health component as well and as well um our partnership with Thrive Toronto is absolutely looking at youth mental health as a specific area. And finally, there are major investments being made, including in the city of Toronto, the universal student nutrition program, uh increases in um uh appropriate shelter and also affordable housing. How long does the that uh take to show up in public health in outcomes? Uh well, I think there's some that could be very immediate. So certainly for that individual who gets housed um you know we know that that is going to provide some stability into that person's life and hopefully we can see you know uh a better trajectory and decrease visits to emergency departments and that immediiacy. But as a as a broader population initiative we know that this takes longer to really see that that bigger initiative to say how is it that harm reduction how is it that housing is having that larger impact across a population and seeing those improved indicators over time. Thank you. Any other questions from any other directors? If not, I have one or two myself. Okay. Um, so in your report, you referenced um maybe I've mentioned it, the hard hub and the the the beds um the crisis beds. Can you speak to that a little bit as to how that's coming along and if we've actually been able to fill those beds? I think it's 27 in total, right? uh to yes it's 25 beds that we have through the heart hub funding um and we have a number of clients the numbers are changing on a day-to-day basis so I I hesitate to really even say because I think today's numbers might be different than what we had on Friday uh in terms of the number of clients being assessed but but certainly through um uh outreach services like our own um our own heart hub services for addictions therapy as well as core services as well as our partner services um through Toronto Community Crisis as others have been referring clients uh to be assessed and uh I believe nine was the most recent is that Dominic that's the more recent number I have available um so that includes uh five TPH referred clients who are either um signed a lease or pending and can you maybe talk about the services that are provided there just not beds being provided so this is um uh more permanent housing uh so People who are tenant who become tenanted into the site um move intowards a rent geared to income um model uh with extreme supports for for wherever they are in terms of their mental health and substance use to make sure that they are fully supported in transitioning into the home. Um continuing to have the kinds of supports that they need to to stabilize through that. We know it is a recovery focused model but people don't need to be in recovery to to be tenanted there. uh we know that there can be you know cycles of of of relapse uh through the recovery process and so clients who would be housed there are supported through that recovery process. Wonderful. And just one final question on our health our city the implementation uh table uh which I chair. Can you maybe talk about some of the things we've been discussing there and some of the successes we've had around that? Uh so certainly the the our health our city and and we you know we didn't provide as as full of an update on that just uh to focus on some of the other areas but but we have our three main working groups um in that table. One of them is focused on the some consumption site closures. That group is obviously very active currently with the announcement of further um closures of two um consumption and treatment services in Toronto. Uh there's also an alcohol uh working group focused on the harms of alcohol and um again we've had a number of uh recommendations moving forward in terms of how people are aware of treatment pathways for people with alcohol addiction. Uh and we're also coming to that table with the um the follow-up and hopefully moving forward on the alcohol labeling strategy that's that's and bill that's being moved from hopefully from Senate to House of Commons to to move that forward federally. And then the third table that is a bit um newer in development is the the mental health and primary care access uh working group where we're developing I think really some of the core um kind of key areas that that people are looking at and we're also looking at making sure that group is very connected with Thrive Toronto which is the partnership with a number of Toronto based mental health agencies and advancing the work through that forum. Wonderful. Thank you. Uh any other questions from uh directors? Seeing none, we'll go to speakers. Any speakers on the item? Okay, I'll start. Uh, Council Chang, sorry. You have a question, Council Chang, or do you want to speak to the No, I just wanted to speak to the item. Go ahead, Council Chang. Yeah, I want to thank uh staff for this tremendous report as well as our uh medical health officer, Dr. Mury. As you can see, our city has tremendous responsibility in a very complex context. And you know, when we hear the many deputations made, we can see that it's hard for one report to capture the breadth of the many health issues that our city has to address. So I I think this is a a good snapshot, but in no way can we um be so comprehensive to drill down to every corner or facet. Um and each of them uh are important to the health of our city. So um I do agree that I hope future reports do capture more about the treatment side and the outcomes of our many investments that are being made. But I I do commend the work and I think um all of our city should be grateful that we have such a comprehensive uh public health team that covers so many aspects of our our health and our daily life in our city. So I just wanted to commend the team and thank them for this report. Thank you councelor Chang. Uh, councelor Ravo, I want to add my uh thanks to staff um to medical officer of health uh for bringing this report forward. Um and just to highlight how many of the concerns uh have to do with intersecting systems here we have um if you think about u the all of the elements that are not clicking into place in Ontario municipalities that would include um having the downloading of social services uh and and social housing to municipalities um in contrast to for example every other province where you can look at what Manitoba is doing uh what British Columbia is doing where you have um child protective services and the whole system uh at you know with the provincial government you have um correction services with the provincial government housing um and healthc care importantly because on the public health side we deal with the um outcome of broken systems um and certainly an important voice for ensuring that there are population level interventions but there are a lot of missing elements here and I just want to emphasize above all of them um housing the the experience of being homeless uh we have learned over time and certainly from um uh medical professionals is that it makes you more ill and that uh being more ill and having to face uh very um threatening situations but even just being cold or being uncomfortable leads people to start to use more drugs. Um so the the number one solution um here is to give people a roof that's appropriate for them as soon as possible in which a shelter is an important piece of that. It's a first step into a home and then with a goal of a long a permanent home longer term. Um and this has such a you know it starts with children. Um uh I think about how many how much work is being done in the city of Toronto to ensure that no family no child is homeless right now and we're doing great work but unfortunately things like a universal student nutrition program which is very you know uh every other country OECD country anyway um and many you know many countries all over the world with very uh inferior uh GDPs have had these measures in place and you know there have examples in other countries where you know you have a period of time where every child received a school-based meal and you look 20 years down the road 30 years down the road uh improved health there. So I I think that with what we have and facing the complexity of what we're what we're facing today um it's it's tremendous and it's really wonderful to see the refocus and recommmitment on social determinance of health. thinking about the mental health crisis and where we are right now. Uh it is significant um and once the children who are reporting at 65% thereabouts that there uh more fragile mental health in all of Ontario, not just in Toronto, when they come of age, we're going to be facing more and more of the outcomes of that. Uh but uh clearly care um investments in um in in caring for people and ensuring that systems aren't broken um is is really crucial here. And I think that the the the big elephant in the room is that there is no mental health care available to people right now who need it most. Not at the scale that's needed and not at the uh in terms of uh publicly funded, publicly available. Um, if you have a lot of resources, you can get care. If you have uh, you know, if if I need help, I have I have benefits. But the majority of people in this city work without benefits. They cannot see a psychologist. They cannot um, they cannot get help when their health starts to uh, waver or there are challenges. And that includes parents with kids who who are the most neglected. Um there there has been a lack of mental health care for children in this province for as long as I've been following this since I my daughter is now 30. So uh I've I've always been concerned about this and I see the decline in what it does. Inequality, income inequality, the high cost of housing, the low wages, uh the high cost of everyday things is a real pressing um uh thing that people are experiencing. And I think we see the outcome of that and the expression of that on our streets, in our communities, um in our own families every day. So, uh it's really precious what we do here at public health and I want to thank all of the staff who've uh contributed to this and and I look forward to the work to come. Thank you. Thank you. Um I Anyone else speak? Okay, then I'll speak then. Again, I I too want to thank uh not only the administrators of public health, but really the frontline workers who do such great work each and every day serving every corner of our city. Um you know, in regards, we don't even notice it, but you know, dine safe and swim safe. Even now, FIFA, public health is involved in all those things. Not to mention immunization of our children. Um we've had uh EMPOX outbreaks, measles outbreaks this year. public health have been front and center in addressing all these issues. Um I don't know our our our city population now sitting at 3.2 million people and public health has been doing uh with the same similar budgets serving so much more of the of our population. Not to mention everyone who come and visit our city every every year for different festivals and events and so forth. Even Taylor Swift for example, right? Millions of people came here and public health was front and center. But you know, we also know that the province supposed to cover 75% of our public health budget and the city covers 25. And in this year's uh budget, uh it was really 6931, right? So we're actually again time and time over again covering the cost that the province fails to to do so. And so that needs to be front and center. But um I just know that uh the work we do here is amazing and I'm so thankful to be part of part of it. Uh I see as chair of the board of health, I see it every day going into different communities and speaking to staff and so on and so forth and showing the appreciation uh to to to us here at public health. So um yeah, I just wanted to say that out loud and uh keep up the good work and thank you for this snapshot. The snapshot really doesn't really show the breadth of what we do here, but um you know it would take the entire meeting for her to do that. So thank you Dr. Murray and team. All righty. Um I will ask uh Director Zho to move that this item. All those in favor post carried. The next item is item number two. Uh which is actions to advance indigenous health. Uh there's presentation on this item. I'll have Dr. Mie speak to uh introducing those who are going to speak to it. Thank you, Chair Moyes. who will be turning it over to uh Monique Diabo who will be speaking and presenting the item. Good morning chair, members of the board. Thank you for the opportunity to speak with you today. My name is Mik Dao. I'm Ganyag Haga Mohawk and Tyino originally from Ganuag Mohawk territory. raised in Kahwan, Alberta, Treaty 6 territory. And this is my colleague and team member Josh Swain. He's Red Raver Matei, originally from Minnesota, Manitoba. This presentation provides a comprehensive update on Toronto Public Health's actions to advance indigenous health. Well, you've received several focused updates over the past year, including those on cultural safety, the indigenous wellness committee, and the indigenous funding stream of the Toronto Urban Health Fund. Today's presentation brings our full portfolio together over the last two years. Well, you'll see how the work has deepened, how indigenous leadership continues to shape direction, and how we're preparing for the next phase of implementation in 2026 and beyond. The purpose of this report is twofold. First, we're providing a broad update on all actions taken since the board's January 2024 report on indigenous health. That includes progress on cultural safety, mental health and substance use, indigenousled vaccine partnerships, funding approaches, and indigenous data governance. Second, we're reaffirming Toronto Public Health's community to culturally safe indigenousled approaches. This commitment is essential to ensuring public health is responsible, excuse me, is responsive to the needs of the urban indigenous community in Toronto. This work is grounded in reconciliation, in reducing inequities caused by longstanding systemic harms, and in honoring the priorities indigenous partners have consistently raised with us. Toronto Public Health's indigenous health work is guided by multiple intersecting mandates. the Ontario public health standards, the city's reconciliation action plan, Toronto Public Health's strategic plan and direction from this board. This work is also guided by indigenous leaders, community members, and knowledge keepers. This slide summarizes the core areas where we've advanced indigenous public health action since January of 2024. Each area aligns directly with priorities that indigenous partners have repeatedly communicated to us. They include mental wellness, reducing harms related to substance use, cultural safety, supportive housing, and social determinance of health, indigenousled vaccine approaches, indigenous funding, data sovereignty, and emergency response. Taken together, these demonstrate the diversity and reach of the portfolio and the shift towards indigenous defined and indigenousled public health pathways. These focus areas work to address critical public health priority areas as communicated by indigenous partners. Mental health and wellness supports, reducing the harms related to substance use, indigenous cultural safety across health services, supportive housing, and addressing social determinance of health relevant to indigenous communities and indigenous self-determined and non-competitive funding. This slide reflects one of the most important shifts in our work. Previously, our approaches were often evolving and time bound with growing recognition of the importance of sustained engagement and strengthening indigenous governance structures. Over the past several years, particularly beginning during the pandemic, we've moved decisively toward co-development, indigenous defined priorities, and shared decisionmaking. Indigenous organizations are no longer contributors. They are co-leaders. Indigenous the shift is grounded this shift actually is grounded in trust. It really is rooted in relationship and it reflects a long-term commitment to working with indigenous communities rather than consulting them. Our team spends a significant amount of time attending and contributing to engagements led by indigenous service partners, usually at the invitation of host organizations. Above you will see some examples of such events. We've been part of the grand opening of Anishnab Health's new purpose-built indigenous health center as well as ado indigenous primary health care and wellness clinics Tdsb indigenous immunization clinic and council fires wellness gathering among many others. We always find a way to balance our commitments to provide internal expertise and contributions across Toronto Public Health's directorates and time spent in community fostering and nurturing relationships and participating in informal dialogue about current indigenous health issues with the organizations on the front line and how we can support. When asked why we feel this is important to dedicate our team's resources to such commitments, we state the following. Visibility, reciprocity, and leadership, drive, trust, and partnership. Consistent presence at community-led gatherings builds rapport and legitimacy, demonstrating that Toronto Public Health values indigenous voices and is committed to meaningful engagement. This visibility, particularly in spaces where trust has been historically fragile, signals respect and strengthens Toronto Public Health's role as a genuine partner. Participation also reflects reciprocity. By showing up for community, we foster mutual engagement and shared responsibility, making collaboration more effective and grounded in relationship. The indigenous health team plays a key role in fostering these connections, bridging gaps between Toronto public health and indigenous service providers and transforming relationships into strong ongoing partnerships. Senior leadership presence further reinforces this commitment, signaling that indigenous health is a priority at all levels of the organization and strengthening trust through visible top-down support. Indigenous leaders are heavily relied upon and contribute a significant amount of their time to various tables, leadership circles, and leadership circles at a municipal, provincial, and federal government level. We at Toronto Public Health recognize that because leaders are pulled in so many different directions, engagement fatigue can limit their availability to participate. By showing up for these organizations, we demonstrate that we value those contributions, especially to our own initiatives like the Indigenous Wellness Committee. This commitment to community and partnerships is exactly what is required to create lasting collaboration and has been a key factor in enabling the strong sustained co-development we've seen within the indigenous wellness committee. This this work began in a good way by following traditional protocol and offering each of the participating organizational representatives tobacco. This reflects our team's understanding of indigenous ways of knowing, being, seeing, and doing and signals that we are entering this work with respect, with intention and accountability. This is not a symbolic or performative act. It represents a commitment to relationship. In many ways, it's seen as a contract in spirit, guided and reciprocity and trust. We've heard directly from indigenous partners and leaders that this decolonial approach has been meaningful and appreciated. By centering protocol alongside our public health responsibilities, we are demonstrating that this work is not extractive or transactional. Instead, it is rooted in ongoing relationship, respect, and ongoing presence. This has helped build trust and confidence with indigenous service providers, reinforcing that we will show up not just for the moment but over the long term. Ultimately, this approach has laid the foundation for enduring partnerships that will well that will carry well beyond the development of the indigenous wellness action plan and support sustained community-led work into the future. The indigenous wellness committee the indigenous wellness committee is central indigenousled governance structure co-guiding this work. It was established in 18 of excuse me, it was established in April of 2024 following this board's direction. And since then, we've convened 13 informal meetings alongside ongoing planning, relationship building, and working sessions. 17 indigenousled organizations sit at the table and all 26 indigenous organizations in Toronto are kept engaged and informed through summaries and validation opportunities. The committee the committee uses indigenous frameworks and research methodologies guided by indigenous knowledge keepers. We want to emphasize here. What we want to emphasize here is impact and engagement. Committee members are giving their time, their expertise and their knowledge on behalf of their organizations to ensure that the plan we ultimately bring forward reflects indigenous worldviews, indigenous wellness, and indigenous priorities. This structure helps address consultation fatigue by creating a stable, trusted indigenousled space for ongoing governance. We are now entering the drafting phase of the indigenous wellness action plan. This work is not only happening externally. We are also transforming Toronto public health internally as well through the indigenous cultural safety action plan. Toronto public health is shifting from mandatory education into more experiential learning and more relationship building and more integration across programs. programs are adapting their practices based on indigenous defined wellness. Relationshipbased engagement is becoming common practice across the division. Staff are attending learning events. Screen screening uh films, guest speaker sessions and evaluation data shows these sessions have a strong impact and relevance. This internal capacity building is essential. As indigenous partners contribute to more of the governance and direction setting, Toronto Public Health must continue to grow its cultural safety practices to be able to work in good relation. Since 2022, Toronto Public Health has been working closely with indigenous service providers to establish a collaborative approach to advancing indigenous harm reduction in partnership with Ontario Aboriginal HIV AIDS strategy and indigenous harm and indigenous harm reduction circle was officially formed in February of 2023. The circle's mandate includes co-developing culturally appropriate solutions for indigenous harm reduction and identifying strategies to address the health and wellness needs of indigenous people who use substances. The beated nlloxxone project is a community-led response to the Ontario government's community care and recovery act which mandated closures of five supervised consumption treatment sites in Toronto by March 31st, 2025, including indigenous serving programs and Toronto Public Health's the works. These closures will disproportionately impact indigenous community members who are already navigating inequities rooted in colonial violence and systemic racism and intergenerational trauma. Inspired by the Yukon Council of First Nations, the Indigenous Harm Reduction Circle has engaged an indigenous beadwork artists to create a beaded nlloxxone kit, serving as the anchor for a culturally relevant awareness campaign that promotes indigenousled harm reduction services and strategies across Toronto. Participating participating organizations include the Native Canadian Center of Toronto, four winds at Parkdale Queen West, Toronto Aboriginal Support Services, Ontario Aboriginal HIV Aid Strategy, TwoSpirited People of the First Nations, and the Women of the Matei Nation. This slide. This slide highlights what indigenous partners tell us they are experiencing as a result of these shifts. We constantly hear we should not be forced to compete for limited funding when we're all working towards the same goal. Reporting needs reporting needs to be indigenous governed and non-colonial. Vaccination services should be indigenousled wherever possible with public health supporting capacity building. These quotes represent a broader theme. Indigenous communities are seeing meaningful changes. Examples include low barrier self-determined allocation of the indigenous Toronto urban health fund funding, the indigenous harm reduction circle, and the beaded nlloxxone initiative, culturally grounded emergency response supports for evacuees, including increased access to oral health and immunization, and stronger collaboration in youth health, mental health, substance use, and vaccination pathways. These are concrete public health impacts. Looking ahead, our work focuses on strengthening indigenous public health capacity through indigenousled partnership. This includes completing and validating the indigenous wellness action plan, strengthening indigenousled mental health and harm reduction pathways, deepening cultural safety transformation within Toronto public health, and continuing to develop sustainable indigenousled funding models. We are moving from doing work on indigenous communities to working with and alongside communities where indigenous partners co-lead and Toronto public health supports through resources, accountability and public health infrastructure for the board. Continued leadership will be essential by supporting indigenous governance principles, advancing cultural safety learning, endorsing indigenousled funding pathways, and ensuring timelines reflect community capacity. We bring forward recommendations in our report for action which we feel will will enable Toronto Public Health to continue strengthening our approach to public health that meets the needs of the indigenous community. Together, these actions will continue moving us forward toward public towards a public health system that upholds indigenous wellness, self-determination, and reconciliation. Hi. Hi NE. Thank you. Thank you so very much. Um we do have one speaker on this item. Uh Brooke Coatsworth line. Excuse me. Um, Brook Coatsworth, are you there? You can see your name on the screen. You want to speak to this item? Can you unmute yourself? Going once, going twice, Mr. Coatsworth. Okay, we'll move on. Uh, any questions from, uh, directors? Go ahead, director Mar. Um, I want to start by saying thank you so much for the report today. Um, I got to read it on the weekend. And as a community member, I also want to just acknowledge how I felt the shift actually that Toronto Public Health has been making in the community as a member. So, I just want to acknowledge that and say thank you so much. Um, and in particular, one of the things that I was really encouraged to see in the report was all of the work around indigenous cultural safety that the organization has been doing because of course partnerships and um the the systems the sort of work that y'all are doing are must be supported by internal work right that's happening within the organization. I have a couple of questions. Um my first question um which you spoke to uh quite a bit was around the IC the the work that the organization is doing around uh cultural safety. I was wondering um if Toronto Public Health is measuring that work. So both in terms of like the implementation of the plan around training um and policy development and partnership approach approaches um but also around the outcomes of the work for our communities um and in particular uh if that work is underway how our communities are being involved in defining what success looks like uh for TPH. Thank you very much for that question u Miss Matter. I appreciate that. Um yeah, so around um cultural safety, Toronto Public Health uh evaluation feedback shows that um we that internally there has been an increased understanding of indigenous histories, indigenous realities and how they impact andor influence the work. There has been greater confidence in applying cultural safety principles and very strong relevance to governance and service uh service delivery roles. Toronto Public Health has also made training mandatory at this point with ongoing monitoring and support for its uh for its completion. She just committee. Yeah. And in terms of how we get um how we include community through the indigenous wellness committee um like we shared earlier um many of the um represent representatives from the 17 indigenous uh service service providers share with us what is needed and how to go about implementing cultural safety in the community. So one of the examples that we shared was through um the our um vaccination programs. So for example something that we have been um directed to do is to allow our indigenous uh service providers so for for an example uh nishabi health Toronto or a doer to first address vac vaccination the vaccination process and when they don't have the capacity for us to go and to support them and that was directly related especially to cultural safety recognizing that when they are having um for example uh vaccine clinics for the Toronto District D district school board. Some of the uh administration and the students would rather see themselves represented in those um teams or crews that come in. Thank you so much. Um my second question was around data governance and um I noticed it was one of the areas in the report. you didn't speak very much to it in this presentation, but I was curious what that work will entail over in 2026 um and what we can expect from that. I'm actually going to pass that question over to uh through the chair to uh our medical officer of health or Emma, our manager. Emma, uh, I know we're running out of time, so I'll just I'll just jump into that to say, you know, um, I I think we're still in development stage for the data governance. Uh, we're certainly working closely with Dr. Janet Smiley, uh, who's a a leader in Toronto in this area in terms of looking at how we can have an appropriate data governance, um, structure to be able to to um, not just collect, but but use and share and have that ownership of any indigenous data we are collecting. We have moved forward on a sociodemographic data pilot project um where we've started collecting this information um through um our healthy babies healthy children program to be able to kind of look at and some of our other um early years programs to see which clients we are ser serving uh and and working with them to understand at the ownership and the appropriateness of of how we would be sharing that data going forward. But um certainly lots more to come I think as in a future update on on how we're proceeding. Yeah, Miss Matter if I could also um add to that. Uh as um Dr. Merty shared, we're working with uh Dr. Janet Smiley. We're also working with um some other uh indigenous service providers on this including call auntie and native men's residents of Toronto known as Nami Res. Thank you. Go ahead, councelor Bravo. Thank you very much for the presentation. It was really great to read it um ahead of the meeting. I on the experiential learning part, I really um I'm interested in whether um you would be looking at um how the how we learn as a board. Um I uh the shift from training to experiential learning is I think a pretty significant part that you commented sta it's really helping public health staff and um I'm just wondering if that's potentially recommendation in the future. I know that something that has come forward is that the board has mentioned that they would like to continue the um cultural safety uh training. So we're hoping to move forward with that in uh 2026 or 2027. And when you're talking about experiential learning, that's actually a really uh great question. Um, counselor Bravo, um, I think on behalf of myself and um, our indigenous health team, we can say for uh, counselors or member of the board to to get out into community. There are multiple gatherings. You know, I spoke to some of the health gatherings. I spoke to some of the more um social gatherings. uh get out into the community, go to those gatherings, you know, experience the gatherings and also, you know, meet and get to know your indigenous constituents because you have many in your areas and that in itself I feel is um experiential learning among others. Absolutely right. Thank you. Thank you. Any other uh questions from anybody? I just have one. Um it was touched on already but uh Are there any gaps that uh you see perhaps that needs to be filled? I again I know that this is a comprehensive report and a lot's been done and um and I'm happy for the feedback that's been received based on the uh the data that was collected from the members, but are there are there gaps that you know they would like us to perhaps address? Yeah, I think I'm going to actually pass that question to Dr. Marty. Oh, thank you chair. Uh, you know, I think we we have made a lot of progress to the space and I think certainly the recommendations are moving forward in terms of not just continuing but actually strengthening um the work that we're doing. So looking at increasing that amount of funding that we were able to provide through the Toronto Indigenous um health fund to further that um the work that we're able to do in that space. I I think really looking at um solidifying making not just indigenous cultural training for our staff as optional but actually moving towards a more mandatory requirement uh to really make sure that we're having that deep penetration um across staff and that there is um you know that that level setting across all of our staff um and then continuing you know we we know we'll have uh evolution of the board um through the end of 2026 and early 2027. And so really our commitment to to making sure that we are moving in lock step with the board in terms of that um that training and providing um yourselves uh you know what we need in terms of that strategic oversight to move this this work forward. Okay. Wonderful. Thank you. Uh seeing no other uh questions on this item. Uh moving to speakers. Any speakers on the item? No. Well, thank you for this very comprehensive report. Um again, it's nice to learn from you and with you as always and uh we look forward to uh hearing any further updates um as time goes on. Thank you so much. Much appreciated. I like your feedback on going into community and seeing for yourself. Um I have had the privilege of doing that many times. Uh most recently at the Anoshabi Health uh center down in my ward on down on uh Cherry Street, I think it is. Uh it's a great facility and I encourage anyone who hasn't been there yet to please go and visit. Thank you. Okay. Uh who'd like to move this item? Okay. Director Mador. Uh all those in favor carry. Thank you. Okay. Next item is uh item three, health impacts of homelessness and update on the downtown core pilot. Um we have a presentation on that. Director um Dr. Murdy, you want to introduce the panel members? Uh I'll be presenting this item. Oh, will you? Okay. Uh but we're thankful to um guests that we have in the audience um from our Toronto Police Services who are absolutely uh key partner in this initiative. So today I'll be providing a brief overview of the health impacts of homelessness and the actions Toronto Public Health is taking, including an update on the downtown community outreach response and engagement or core pilot program. We are bringing forward today to support Toronto Public Health's commitment to advancing the health and well-being of people experiencing homelessness, an issue that continues to affect many Toronto residents. To provide a brief for overview, at the end of January of 2026, there were over 11,000 people experiencing homelessness in Toronto. Indigenous, racialized, black, 2SLGBTQI plus communities are over represented among those experiencing homelessness. Based on birth records assessed before the pandemic and since and in collaboration with Toronto-based network, Young Parents of Noix Address, we have consistently seen that approximately 300 births per year are to people experiencing homelessness. An extensive body of evidence shows that the physical and mental health outcomes of people experiencing homelessness are worse than the general population. Compared to housed groups, people experiencing homelessness are at increased risk of premature death and have a higher incidence of chronic and acute health conditions including infectious diseases, diabetes, cardiovascular disease, and respiratory disease. Acute drug toxicity is identified as the leading cause of death among people experiencing homelessness, contributing to 55% of the reported deaths in 2024. In Toronto, the median age at death of people experiencing homelessness in 2024 was 50 years old for males and 38 years old for females. By comparison, the median age for death at the Toronto general population was 78 for males and 85 for females, almost a 50-year gap for females. Homelessness can result in health harms across the lifespan and negatively impact as individuals health trajectory over their lifetime. The health impacts of homelessness are clear. Downstream health care costs of homelessness are also substantial. Annual healthcare expenditures can be roughly seven times higher for people experiencing homelessness compared to housed individuals. Toronto Public Health plays an important role in surveillance and leads the collection and sharing of health rellated data for people experiencing homelessness. Given the extensive health and social impacts of homelessness, these data are important for understanding the health care needs of this population. In addition to surveillance, Toronto Public Health undertakes a range of actions to protect and promote the health of people experiencing homelessness, including direct program delivery and collaboration with city partners. The staff report includes Toronto Public Health initiatives as examples of this work, and I'll highlight just a few of those today. Our homeless at risk prenatal or heart program is a community-based program delivered by public health nurses that supports individuals who are pregnant and experiencing homelessness, including those living in encampments, respbit centers, and adult only shelters. Our communicable disease investigation and outbreak liaison program leads public health management of outbreak investigations within the shelter system and supports respiratory season preparedness. Toronto Public Health's mobile dental services provide preventive, minimally invasive, and restorative dentistry directly in community settings such as community health centers and shelters, supporting oral health needs that often go untreated due to homelessness or unstable living conditions. And our newer initiative, the downtown core program, is focused on the is the focus of the next few slides. In December of 2024, Toronto Public Health and Toronto Police Services launched the Downtown Core Pilot Program. For this collaborative program, public health nurses are paired with police constables to deliver integrated low barrier mobile outreach and case management in the Young and Dendas or Sancopa Square and the surrounding area. Downtown Core aims to connect people experiencing homelessness, mental health, and substance use challenges with health, social, and wraparound services. This hide highlights some service metrics of the downtown core program up to January of 2026. public health nurses uh during their nursing shifts documented 8,431 client interactions across 568 shifts working alongside police constables. 90% of these interactions were initiated by the downtown core team reflecting the proactive outreach approach. Police constables work with nurses to support a safe environment for clients, staff, and the broader public. They can also assist with system navigation for services within their purview, such as legal aid. During program shifts, clients most frequently received psychosocial supports, which was provided during 97% of shifts, as well as medical support, which was provided during 63% of shifts. There were 265 clients served through case management, which most often involved helping clients access emergency or transitional shelters, primary care, identification services, income supports, and accompanying clients to appointments. The downtown core team has supported securing housing for nine clients through case management services. Public health nurses addressed clients immediate medical needs through overdose response, emergency care, and supply distribution, including nlloxxone and food. Toronto Public Health conducted an evaluation in February of 2026 to inform the pilot's next steps. This included a survey with clients, focus groups with Toronto Public Health nurses, and program management, as well as review of the program data. The evaluation demonstrated that public health nurses are providing proactive outreach and on the spot support to connect clients experiencing homelessness and complex health needs to health, social, and wraparound services. The most beneficial impacts of the program were addressing clients substance use and addiction needs and connecting them to housing and identification services. The evaluation identified opportunities to enhance the program, including expanding the scope of the public health nurses, strengthening referral pathways, as well as the Toronto Public Health and Toronto public or police service collaboration. There are several key recommendations, including for the downtown core pilot. The downtown core pilot program should be extended for an additional 18 months to build on what we've learned to date while allowing additional time to continue to assess the pilot. Staff will report back to the board of health with final recommendations on the pilot in the third quarter of 2027. We will continue to work closely with health system partners and relevant city of Toronto divisions and agencies to improve the health and well-being of people experiencing homelessness. This collaboration is essential to addressing complex health and social needs and strengthening interdivisional outreach and case coordination. As a next step, Toronto Public Health will review the evaluation findings from the separate program evaluation commissioned by the Downtown Young Business Improvement Area once they are available. The downtown young BIA sits on the downtown core advisory committee which oversees the program and is co-chared by senior leadership from Toronto Public Health and Toronto Police Service. TPH has actively participated in the downtown young business improvement area evaluation process by sharing program data and through staff involvement in the evaluation activities including interviews and focus groups. Toronto Police Service is also engaged in this evaluation. Pending extension of the downtown core pilot program, Toronto Public Health would move forward with implementing enhancements identified through the evaluation. This includes strengthening collaborative service delivery by Toronto Public Health and Toronto Police Service as well as improving referral pathways to primary care. We will examine the impact of recently implemented services that aim to provide more on the spot clinical care. This includes expanded public health nursing functions such as basic wound care introduced in February of 2026 and immunization services that began just last week. Finally, we would adjust the catchment area to improve better service coverage to better meet clients where they live, gather and access supports, and to strengthen coordination with key community organizations and city divisions. As shown on the map, the primary service area would be slightly increased to the north and the south, represented by the lighter blue area on the map, and the red outlined would not be part of the primary service area. However, this zone represents locations where outreach and engagement would occur on an ad hoc or as needed basis. In closing, I would like to thank Toronto Public Health and City Staff, our colleagues at Toronto Police Service, and other partners for their ongoing collaboration and commitment to improving the health of people experiencing homelessness. Uh, thank you, Dr. Murdy. Uh, I see we have some speakers on this item. Uh, first up is Pauline Larson. Are you here, Pauline? She online now. There she is. Yeah. Pauline, can you hear me? You can. Go ahead. You have five minutes. Excellent. Okay. Thank you so much. Uh, Chair Moyes and Dr. Merty and members of the board of health. Thank you so much for having me here today. Um, just trying to get my camera started. So, you should see me in a moment. All right. Does that work? We haven't seen you yet. All right. Shall I just get going rather than uh hold things up? Go ahead. All right. So, uh, let me start by saying that uh, I'm here to debute today uh, in support of Dr. Mertie's recommendation uh to extend the community outreach response and engagement pilot in the Young Dundas area and until Q3 of next year. I thought I'd start with a little bit of an overview about who downtown Young Business Improvement Area is, especially for those of the new board members who haven't uh come across us before. Uh we are the business improvement area around the Young and Dundas neighborhood and we represent approximately 2,000 businesses as well as commercial property owners with a combined commercial property value of just over $7 billion. We're one of the largest BAS in the city and we generate approximately $850 million a year towards the different levels of government uh government revenues uh municipal, provincial and federal. We have always taken a very intentional and collaborative approach to community safety and well-being. Uh that started a decade ago in fact in 2015. And uh for instance, we have funded a full-time outreach program that uh that serves the community in our neighborhoods since 2018. And since 2021, we have coordinated a weekly partnered outreach program with uh up to eight or nine diff different onreet partners, including um partners from the works uh when the supervised injection site was still open, as well as our neighborhood community officers as well as M DOT and streets to homes among several others. So our goal is to provide wraparound services to clients on street and to support uh community safety and well-being in the broader neighborhood. So, we would like to acknowledge that in a neighborhood where community safety and well-being has been raised as a concern in recent years, the core pilot has made a really significant impact, not only for uh access to services for their clients on street, but also to the greater sense of care and safety in the neighborhood at large. And for us, of course, this is something that is is very critical. The medical officer of health outlines clearly and extensively the benefits of the core pilot on people experiencing vulnerability and homelessness in her report. Um but in addition, we would like to underscore the heightened sense of care and safety that core brings to the broader downtown uh young neighborhood. Since 2018, uh, we have undertaken an annual safe and inclusive neighborhood survey to assess levels of perceived and actual community safety and well-being in our neighborhood. We include employees, residents, students, visitors, and business owners in this survey. And in 2025, the survey, which was undertaken in September, just eight months into the core pilot program, asked about awareness and interaction with the core team. We found that 21% of all survey respondents and again that's across business owners, commercial property owners, employees, residents, students and visitors in the neighborhood were aware of the core team and a further 5% had interacted with them directly. I really want to highlight how positive an impact that is in a program which was only eight or nine months in at the time um and which has you know created a very high level of awareness over that very short period. More broadly we at Downtown Young are dedicated to working collaboratively with the city of Toronto among others on safety initiatives that focus on the intersection of both safety and well-being. We see those as two sides of the same coin. Um, as Dr. Mury mentioned, we do sit on the core advisory committee. We also co-cho co-chair the city's downtown east leadership table and have done so since 2025. We are an outreach provider that participates in the downtown east focus table. Um, and we also are active participants of the young Dundas safety network uh, which meets every three weeks. Uh finally, we also partner and have done since 2023 with the city safe to community safety plan on the safe BIA program which is funded through the city but based at downtown Young. So those are my remarks. I just wanted to say again, thank you for the opportunity to submit this uh to submit this deputation uh in support of the recommendation and I hope to look forward to continue to work with the team at core and at the Toronto public health um as we go forward. U thank you very much. Thank you. Thank you. Any questions for the deputent? I do have one. Um so Pauline you mentioned that 21% of people surveyed are aware of the program and 5% has interacted. Um have have have the business community and perhaps residents in the area have they seen an improvement in public safety or perhaps uh you know perhaps less disorderly behavior in the area in your catchment? So I my response would be specifically with regard to the perceptions of safety because I think that what is often not fully understood is that people don't come to areas where they don't feel safe and safety and crime can be very very different things. There is a greater sense among our membership and also the larger stakeholders that we work with in the community that there is that there is care being shown um to individuals that are on the street that there is a compassionate response. It is a multid-disciplinary and collaborative response which which from our perspective is highly effective and for us that has made everybody feel like okay we're doing something we're actually trying to help we're trying to provide solutions and from our perspective that is probably has the most positive impact on community safety uh as anything else. Um I think in terms of the actual change as as Dr. Marty's data showed 8 and a half thousand engagements is a pretty impressive number over just on a year period. Um and I think they speak for themselves in terms of um in terms of how many people are being helped and provided with resources. So yes, overall I would say this has created a very positive impact on the broader community. Well, wonderful. Thank you. Those are my questions. Sorry, Director Zho has a question for you, Pauline. Absolutely. Hi, Pauline. Thanks for the um wonderful letter that you put together with all of the data and I'm really curious what the data looks like now because um the data you mentioned was from 8 months into the core program and and correct me if I'm wrong, but um the core program started between 2018 to 2021. And so I'm just kind of curious what kind of improvements have you been seeing um in 2025 2026. So it's a great question. It is an annual survey. So the last one that was done before that in 2024, the core uh pilot had not been yet launched. So this is the only year where we've been able to ask the question about uh people being aware of or interacting with the core pilot. Did that answer the question? Right. Thank you for answering the question. Um I guess just to follow up on that is um you're tracking the data year to year by year and determining um the business owners, the visitors um impressions of increased safety. Um and so there is a like there is data being collected currently on um decreased number of breakins for instance um thefts um overall sentiment of safety. Is that kind of the metric that you're you're looking at? So, no, this specifically is an annual survey that is conducted in September of every year asking people around do they feel safe, what makes them feel safe, what makes them feel unsafe, how have they seen various different interventions. We ask extensively about our own outreach program to see if that is being wellreceived by the community. We ask about our neighborhood community officers. We ask about experiences uh of various different types of incidents, but it is a once a year survey that specifically asks about perceptions of safety and an understanding of how the neighborhood has improved or not uh over the course of that time. We've been doing those surveys, as I said, since 2018, but the core question was only asked for the first time in 2025. Great. Thank you for clarifying the answer. Absolutely. Thank you. Any other questions for Pauline? Seeing none. All righty. Up next is Beta Sini online. Uh beta, are you there? Hi there. Yes, I am here. You have five minutes. Go ahead. Thank you. Thank you. Uh good afternoon and thank you chair. My name is Beta Sinani and I'm with the Canadian Drug Policy Coalition, a national nonpartisan policy organization working to support the implementation of drug policy grounded in public health and human rights. As the most populous municipality in the province, we prioritize making this appearance today and we urge action from this board and your counterparts across the province. And I'm also here as a Toronto resident deeply concerned by decisions that will impact my community. I'll be addressing the recent defunding and possible imminent closure of additional supervised consumption sites which will have disproportionate impacts on people experiencing homelessness in Toronto. While surely not everyone who is homeless consumes drugs. And while not everyone who consumes drugs is homeless, peer-reviewed research shows that in 2021, one in six people who died from opioid toxicity in Ontario was a person experiencing homelessness. The defunding and closure of supervised consumption services will significantly harm people who use drugs, people who experience extreme poverty and homelessness, gender minorities, women, and indigenous people. These have implications for this board's reconciliation efforts as well as other frameworks designed to reduce health disparities among these marginalized populations. Access to addiction treatment and access to harm reduction must go hand in hand. It is widely accepted that for anyone who chooses to do so, the pursuit of abstinence is not a linear process. The increase in overdose risk immediately following a course of addiction treatment is well documented in the research and therefore harm reduction and supervised consumption must be made available alongside one another. The unregulated and toxic drug supply is leading to increasing rates of death and irreversible injuries such as hypoxic brain injury. Just frozen. Hopefully she reacts. Did we lose her completely? Uh beta, you can you hear me? Thanks. Looks like this is a city problem. We'll wait for a minute. creating barriers for renters who may consume drugs by passing bill 10, the Protect Ontario through safer safer streets and stronger communities act, which punishes landlords with significant fines and uh possible imprisonment for knowingly so-called permitting people who produce, share, or otherwise supply drugs in their rental unit. This will mean fewer landlords will rent to people who use drugs and may increase evictions. There will likely be hotspots of overdose emergencies in specific areas of the city should the site closures be permitted to proceed by this board. My recommend my recommendations to this board are as follows. One, take all action necessary to ensure the remaining sites in Toronto which have been defunded can remain operational. Two, request that the medical officer of health work with other city divisions and urgently set up an emergency response table that includes paramedics, library workers, supervised consumption site workers and clients, drop-in and shelter workers, and other community organizations and medical professionals to participate. uh request that the medical officer of health work with the Toronto shelter support services on a strategy for providing medical directives on oxygen for shelters and drop-ins. That was three. Four, request that the medical officer of health provide a follow-up on the anticipated impacts of the SCS closures report and include a summary of current impacts and recommendations. And five, please make a statement supporting supervised consumption sites services as public discourse matters and evidence and expertise in disease prevention must guide our policy. Thank you. Thank you so much for your deputation. Any questions for the deputent? Thank you so much for coming in today. Uh, Norad Uzide. Norad. Not here. Okay. Uh, Brooke Coatsworth, not here. Okay. Sev Taylor. Uh, council, can you change your camera on? Uh, Sev Taylor. Here we go. I see SE down below here in my screen. Sev, can you go get off mute? Here you go. Hello. Uh before my five minutes start, Beta is on one minute. So I see the floor for the moment. Thank you. Sorry. Uh so Beta Beta is expecting to speak uh for one minute. Beta spoke already for four minutes, I believe. So I see my time for the time being. I'm not quite sure what you mean by that, but uh it's your time to speak. You have five minutes. Go ahead. Okay. Um, so watching single tensity. Hi everybody. Um, let me see if I can video on. Okay. Hello. Um, my name is Dev. I'm a harm reduction worker. Um, it's difficult to talk about this. It's almost like there's two sittings, right? Uh, and I feel like I have one foot in both. Um, I don't have a fixed address at the moment, but my friends have been very kind. Um, you know, I I have like I've been to university. I've also been the person sitting on the floor outside having a panic attack and a police officer walks by and I fear that um my distress is going to be taken as an indicator of threats. Um, I've written about my experiences with the mental health system and an article which if I may like to point you to it's it's at uh 999 queen. com. It's 999 queen west.mmedium.com. But uh my main point I would like to bring today for consideration concerning the extension of the core pilot project is that I completely vibe with the concerns that have been stated about the health impacts of sleeping rough. I think it's also very important for the board of health uh to bring it sustained attention to people's honest experiences of institutionalization. Um whether that's through direct coercion or whether they have to be in a shelter because there's no other survivable option that night. Um I'm not trying to impugn anybody's good efforts here. point here is simply to bring up that uh I think that if we're taking a city level equity focused just health approach here then out of sight out of mind is not sufficient. Um what I'm saying is that just because somebody's off the street they may still need to be checked up on because for as much care as is provided in these um these respit institutions hospitals etc. Um, there's also a lot of stuff that say Duncan Campbell Scott would be really proud of. So, um, I'm tripping on my words. There's so many things I wanted to say, but since so close to home for me, um, I guess I would just encourage also my fellow frontline uh, workers, including the TPS folks who are who are here today and who are involved in the core project to just really look after your health on a profound level. um maybe reflect on what Sang Kofa means to you. To me, uh I won't I don't have time to get into my whole my whole background. I'm a settler here. Um but I I vibe with the proverb associated with the Sofa uh a symbol and that proverb is often translated as it is not taboo to go back and fetch what you have forgotten. So yeah, the more that frontline workers can proactively center themselves and operate from the best instincts that brought them to to whatever profession rather than from any stigma or snap judgments, um fear, aversion, pity, anything like that. That's going to be that's going to be a major health factor for the population as a whole. And I would particularly encourage uh JPS folks in the room to consider picking up this book, share it with your colleagues, use some of the program budget for it. Uh it's called My Grandmother's Hands, and it's it's a really powerful tool for what I like to think of as restoring the circle. This is a little tangential, but uh I was chatting about this with my partner and colleague, Tyler Core, who has a background in construction engineering and is a nurse. and um we got to talking about the tiny shelters. And so he he really wanted to advocate for that um as a community-led measure for helping people transition away from sleeping rough but in a way that's consensual. Uh again reminding you all that self-determination is a is a very important factor for minimizing the harms of emergency response and also like helping people to get connected with the housing situation and the lives and community that are uh that are aligned for them. And Tyler said what matters is the people that they get a fair sheet in a decent life, a chance for a comeback story, dignity, respect. Thank you all very much for your time and uh for the work you do. Uh thank you very much uh Sev. Uh any questions for deputent? Seeing none. Thank you for coming in today and sharing your thoughts with us. Uh next up is Daniel Tate. Is Daniel Tate here in the room online? No. Okay. Thank you. Uh we'll take it in house. Uh Director Chandra Valen, I think you have you have a question. Go ahead. Um thank you Dr. Marty for the update. happy to hear how things have been progressing and all the work that's being done to evaluate. I think data is always the most important thing especially when it comes to pilot projects to see how we can better uh service uh the residents that we're hoping to service with this program. My question is um I know you're expanding area, you're expanding uh scope with the wound care immunizations. Um what do you see as the um like what is the pathway from the these pilot projects? So, we're expanding, but then is this something that we are hoping to make permanent? What are the variables um in making this a program that's more permanent? And then I have a follow-up question to that. Yeah. To the chair. Uh thanks for that question. We have only really just recently started the actual full scope of the nursing component to this. So, as mentioned, the wound care only came on online in February and immunizations only started last week. So really the the intent of extending the pilot was to to see now and um that that fuller ability to provide nursing services through this partnership and the outreach model and then be able to re-evaluate to say you know what what has the the benefit or change been um when we're able to do that more full scope um nursing offering and into this slightly larger area that we that we have been noticing where clients are um I'd say you know in the past our the nurses have been going you know ad hoc to those areas anyway um and just seeing that many of the clients we were trying to reach are in those areas. Uh I think in terms of the the future state, I don't want to presuppose what the the 20 the 18-month evaluation will will say. I mean, I think certainly we've seen already a lot of benefit in terms of this partnership. It's it's a bit of a novel approach. Um and I think we've heard from the deputants as to what's there. Uh I I think we would really, I think, want to see, you know, is it um is it sufficiently different than other types of outreach that we already have? Uh certainly we know that there are many different types of outreach happening within the city. We know that there's sort of expansion of other services within the city. How is this type of service best coordinated in visav those other services? Um and is the need there? So I think that's where we be really focusing the attention of the the future survey if this is extended. Um do you think with Thank you. And for at that 18-month part, do you think that part of that conversation will also be if there's anywhere else in the city that could uh also benefit from the service? Is that something that you're exploring or not at this time? Uh I think the focus of the evaluation would be on the the the ability to serve within this current um zone. Uh I I think we'll have to see if we're going to put into scope the expansion. I I mean certainly we have funded this um pilot project through cost share dollars. Uh I think the other variable between now and when we bring forward that evaluation would be to see what our mandate is in the forthcoming update to the Ontario public health standards um and their ability to continue this type of outreach work and and really what is the nature that we might need to to focus in on. Uh so certainly right now um the current public health standards has a heavy focus on outreach making sure we're supporting people um who are using substances uh doing this kind of nursing work in the community. But I think would be, you know, if there's any other direction from the province as to what we're funded for um and what our current fiscal picture would be at that time as to whether be able to look at an alternative option. Correct. Thank you. Thank you. Uh councelor Bravo. Thank you, chair. Uh I simply had a question about um uh the after hours care or case management. Uh my understanding is this uh uh program runs during the day. Um, but the people who you might see and whose cases you're caring might have a, you know, there might be an interaction after hours with other workers from streets to homes or the multid-disciplinary outreach teams or Toronto Community Crisis Service. Will part of the evaluation look at whether that handover is is happening adequately? because I I asked because I um you know we get a lot of reports from the Toronto uh shelter division and to economic community development committee and one of the um areas of just of to watch is people not having to interact with multiple uh workers and um and have interactions that then that are then confusing or that we don't have sort of the full picture of what that person's going through. Uh I will start but I'm also going to turn over to um one of our directors maybe to answer that a bit more um and as well if um our colleagues from TSS want to add to that. Uh you know certainly as part of the pilot now um the Toronto public health outreach workers are are certainly coordinating with um known others entities in there. I think absolutely that's going to need to be the case in the ad hoc area where we know many other services are in play in terms of interacting um you know the one-off interaction where we may be handing out food I I'm not so concerned about but certainly when we're taking on clients for that case management we are absolutely doing our due diligence to make sure that are they connected to any other services are they already receiving case management through other places we don't want to duplicate that service so making sure we're we're doing that connection there but we um I think I'll turn to Dominic if they have any thoughts about where we could uh further evaluate that in the the future evaluation. Yeah. Thank you. Thank you Dr. Mury and through the chair uh to you counselor. Yes. So we are engaging in conversations with other city divisions serving this population. Um so those efforts will continue to ensure that you know there is coordination uh in terms of how we're serving these clients. Um, I'd also note that, you know, this is a population that at times is challenging to locate and, you know, access and sometimes those redundant or, you know, extra engagements is probably a better term, um, are supportive in terms of, you know, ensuring that they're getting connected to the care and supports that they need. So, yes, these conversations are ongoing and we'll continue to coordinate with our partners. I I guess my what I really want to focus on is the handoff. Like we do we have a systemic way to hand off that information to uh the people that will take over after hours cuz in a 24-hour period a person might have needs or be in crisis etc. And it's I think a um a ch it's a challenge for the people that are going to be operating or on both sides like having a systematic and systemic way to have a picture of people that um you're interacting with largely because I think a big part of this work is making a connection, building trust, connecting to services, getting people indoors um and other help they need and eventually into a housing or supportive housing. Um, so if what I want to know is that will that be part of the evaluation is sort of being taking a good look at whether that how that handoff is or isn't happening and what needs to happen to make sure that it occurs. And if we're not building into the assessment the the need to ensure that there's um a complete picture of the individual, then we might not get a real sense of its effectiveness. Um and of course you know sometimes um uh it's a it's a also a value for money question uh around whether we're really serving that person and um and and and I and I don't want to unders I don't want to underestimate or devalue that a lot of there's a lot of interest during the day the operating you know a thriving downtown an important square but you know the individual is 24 lives 24 hours a day so just want be really clear on that and I don't know if we need a motion to that effect. I mean certainly I think our intent would be that are we you know how are we best utilizing this resource and how that is within millia. So I mean we can definitely commit to having that in the evaluation as is now is is being embedded to make sure I mean we do have after hours we have evening services um reach as well but really evaluating that that handoff in connection. I know we have 20 seconds, but I don't know if um I just turn it to Gourd from TSS if you want to speak to anything about um larger coordination efforts. Yeah, thanks uh and to you chair. There's more work to do here. Uh there's more work to uh better coordinate and integrate the various teams across the city in various geographic areas and uh to make sure that the service delivery is seamless so that regardless of sort of who individual interacts with that they are getting a seamless case management plan and support. So, I think there's more work to be done here and certainly we've got council direction uh to undertake this integrated work. Uh and so that's certainly at the forefront of of our conversations currently. Thank you. Hey, thank you. Uh any other questions of staff? Go ahead. Director Madori. Thank you so much. Uh my one question is just sort of building on the previous questions but is around the extent to which we're connecting folks to um to culturally grounded to relevant supports. I think the report noted that um you know the the disproportionate impact of homelessness on first nations and mate folks on black folks on 2LGBTQ plus. So I'm curious the extent to which uh the wraparound services, the navigation support is connected to sort of like mainstream system pieces and the extent to which we're we're connecting into those other other organizations and supports that exist uh tailored for for specific folks. Uh yeah to the chair um we have been uh routinely asking as part of the core program uh about indigenous status to to ask if you know as we're referring clients to other services is that you know a service that they would like to be connected to or or interested in. Um only more recently we started having that data captured um more systematically within our data system to have a better sense. We did do kind of a point in time um survey to of just 77 clients to look at um that that data as to to what was the the racial indigenous status of clients that we were serving. Um and I'm just trying to look for that number that we had in terms of the proportions. Certainly a number were identifying um as indigenous and you benefiting from the referral to those uh culturally specific resources when when that was identified. Um I think we have heard certainly from um other service providers in the community that that this is uh you know that that's an important connection that we need to continue to make as well. I don't Dominic, you want to have that number if you have it handy? Yeah. When we did the survey, 35% of respondents of the clients that we engaged identified as indigenous. Yeah. And just a followup that I think it's absolutely important for First Nations in MAT. There's also likely other populations, right, that that would be important for as well. And I just wonder how that could be integrated also into the um the pilot. Great to think about. A question here or that was a comment. Okay. All right. No worries. Uh any other questions of staff? I I do have one myself. Um so the financial district BIA uh has requested that the core team also cover Union Station. uh can you speak to perhaps uh the services that the core team already provides in the Union Station or I know it's not listed in the new boundaries but perhaps you can speak to the work that they do there. Thank you chair. Um so it is not part of a primary zone. Um, but as we are interacting with clients, if we know that, you know, we've heard, oh, that they might be at Union Station, then certainly that that's that ad hoc ability to go there to continue that engagement with a client that we've already been engaging with who is who's generally more located within the primary zone. So, we do have, you know, we're not trying to solicit new clients within that area. We know that there are a number of individuals as well as a number of services within that area existing already. Um, so we're not looking to to duplicate um the other types of services that are already there. um and that we're looking to to better coordinate, you know, how we're um uh making best use of the resources that are within that area. But certainly if there is a client that we are already providing case management or support to um we would we would go there to to support them. Okay, that's good. I see Director Zho has a motion uh specific to that, which is fine. Um I do have another question though. Um so I know that this the court team is um first of its kind in the world. I think I was told uh by someone um I'd like to maybe hear from Toronto police as to what they're hearing on the ground and how people are interacting with uh the police and the uh the nurse in that we know that sometimes the most marginalized and police servants always you know CI2i. So how has the engagement been so far? So this has been a journey probably um years in the work consultation you know trying to bring um partnership. So we're talking about mental health being health and should be healthled and and and our service trying to use a public health approach to that and we understand that. So it's difficult to say we're coming in to assist right in outreach for mental health when we also should be stepping back. So, it's been a very difficult conversation, but I think there's al always going to be a time where the police might be needed, but not in this case. I think you also can't we are transitioning though. I think the whole world is transitioning on how we respond to mental health. And so, there's going to be a lot of time where we're assisting each other. We're supporting each other as we find a new path and a new way to assist our community in all the ways that they need. Right? So, I think this is unique and I don't know what the end of the 18-month receive that extension will do, but when you hear and you're walking and and it's difficult to to really measure anecdotal when someone says like the core team is my new family, right? Because they're taking the time, they're there. When have the police been able to really not be tied to 911, not be tied to to actually have that time and ability to partner with medical professionals to do that actual outreach and to build trust. And that trust, you know, comes in on foot but leaves on horseback. So, and we know that and we see that all the time. So, we know that it takes that time to be there, to be present, to be visible and to partner, knowing when to lead, know when to follow, right? And I think hopefully something amazing grows out of it. But I think that we're providing a service to people who didn't have that service before. And it's unique because we are bringing primary care to people who don't have access to it, who don't have cell phones to follow up to know if it is it Monday, when's my next appointment with a doctor. So to have this kind of support and to figure out what we do next, um has been interesting. And I think when we put out the job call for police officers who want to apply, you are going to get very specific people who want to do this type of work, right? So, we had a social worker who's become a police officer, a new police officer, and he is chomping at the bit to come and work on the team, but he has to do his recruiting time even though he's further into his career, but we're giving him an opportunity to come for 3 months because there are people who, you know, we wear many hats, right? So, it's it's just happy to see that we're we're working together. There are opportunities for improvement, but we're in transition and I think what we're doing is unique and a little difficult, but it's impactful. So what adjustments have you had to make uh from the start of the program to now because you know because it's so new I'm sure there's been some uh steep learning curves right so you've had to adjust somewhat so what adjustments have you made or have had to make so I I think this will be really a a Toronto public health um because it's a lead even though it's a partnership I think from TPS it's adjusting ours so you know not that it's right but we pivot very quickly we're here we're able where do you need us and understanding that you It takes time that our partnership uh is important to build all of this. So I think the only thing we've really adjusted is um like the time right to to ensure okay are we're evaluating this. So are you know are we required after 10:00 at night still right or do we have to be shifting like the times and the schedules etc. So, I think that's probably one of the biggest adjustments and and learning to work together, right? Um, you know, we have our training on deescalation, on trauma-informed care, but it's not the training that um that obviously Toronto Public Health would get. So, that cross training that developing that the changing the the roles of the nurses, adding responsibilities to them and and having to pivot pivot pivot because we had the closure of the sites right when we were get almost getting ready to to launch. So, so yeah, it's I think the adjustments haven't been impactful enough to impact the clients, but I think Toronto Public Health should probably lead some of the adjustments that they've had to make. There's a lot more. So, to that then to public health, what adjustments have you had to make, Dominic, in the program? Yeah, thank you. Thank you for the question, uh, Mr. Chair. So certainly, you know, um, building on what Chief Superintendent Skinner has said, we've made some, uh, logistic and operational adjustments in terms of our scheduling. Um, you know, we see a lot of clients during, you know, regular business hours when people are sheltered often at night or found shelter spaces. Um, you there's a reduced need there. So, we have tweaked that and allowed for more administrative and back off back office functions later in the evening. Um, as Dr. Murdy mentioned earlier, you know, we've done additional work to stand up the uh wound care, the immunization, those nursing functions, and moving forward, we've seen some opportunities in respect of, you know, trying to locate some, you know, space in which to um see clients for the ongoing case management. Um so, we're going to continue exploring these and certainly, you know, over the next 18 months as we roll out the uh uh nursing functions um in greater um we'll be looking at those in greater detail to see what additional tweaks we might need to make. Thank you. Need a motion to extend uh director Balon. All those in favor? Post carried. Thank you. Any other questions to be asked on this item? No. Let's go to speakers. Uh any speakers on the item? I just want to say that, you know, it's been a great program. Uh great team that's leading this uh program. I've been here from the inception of this to to today and I've seen the the great uh work that's been done firsthand. Uh last year I was actually went to a community barbecue uh with the clients they serve as well with Toronto Public Health and Toronto Police. It was a great time. Everybody was happy. So um it we've really come a long way and I'm so really excited to see uh what the next 18 months will provide. Um and again it's extraordinary that they have actually engaged so many people and I being the council in Toronto center you know even speaking to the merchants and and and just people generally and though the the downtown young BIA folks they have nothing but praises for this program. So it is doing what is intended to do and be and beyond. So, um, thank you to, um, all those who, um, make this a success. Toronto Police in particular, Toronto Public Health, and all our community partners. And with that, um, I'm going to ask, uh, Director Zho to speak because she has a motion. Uh, yes. So, I added, um, two amendments uh, to the motion. I'm not sure if you wanted to put it up on the screen for others to There it is. Um, yeah. And so it's been very clear from the speakers on this item that uh uh the core pilot program has been very successful um especially at um managing the intersection of safety um of the individuals who move and work around um the downtown um uh Young and Dundas Square area. Um and based on the um letter submitted by the NIOP Greater Toronto Financial District BIA, Waterfront BA, and Toronto Downtown West BIA, um they strongly encouraged uh this program be expanded or to include the expansion of Union Station uh which also um is a very populated um area and um and is an often it's a place for um individuals who are experiencing homelessness uh to stay especially during the uh cold winters. Um so my motion is just to um recommend for the primary service area boundaries to explicitly include Union Station and also for the medical officer of health to engage with some of these key stakeholders in how we can um provide the same level of benefit that we do for the um downtown young BIA as well. Okay. Any questions for the uh mover of the amendment? Go ahead, councelor Bravo. I I'm just wondering if um the the there's been any conversations with uh other divisions involved in potentially in these areas um with the Toronto Shelter Services and Supports Division. uh just in advance if we're to in terms of how plans to do um like integrated work that we've described are may be underway is that has that already happened? Okay, I see I see yes from the uh thank you perhaps you want to speak to this Gordon. I mean just to say that you know there is planning underway uh currently between Toronto public health uh social development ourselves uh core team Toronto community crisis and streets to homes about how we might work in a more integrated way and specifically in places like Union Station. So that work is underway um and we'd be happy to report back at a future meeting on where we're at. So this impetus is really um beyond what the BAS are requesting which is a very legitimate voice here but it has to do with our social service planning um and our way our kind of case management approach um to do something really intentional. Great. Thank you. Okay. All right. And so we're okay with this uh amendment that's bring forth. Okay. Again, in my question to staff earlier, I did ask if the core team actually went to Union Station and they said that they do, right? But u not for any new cases, but for they engage their clients that they're engaging with. But um that's fine. Um, seeing no other speakers, I'll I'll just be quickly to say that I thank you for the um the emotion, uh, Director Z, and I think we have a really good opportunity here to uh, try um, a really intentional ways to resolve some of the questions that um, I had and that director matter had uh, about who should interact, when they should interact, how they should interact, how we're gathering the data about the people, not just about ourselves, in terms of the services that we deliver but about how the impact is on the individuals and what um how do people move through these areas etc. Um and it make it very outcome focused. So I appreciate the the motion. I'll be supporting that. Thank you. Okay. Thank you. Uh we'll put the motion on the screen by director Zo. Okay. All those in favor? Post carried. Item is amended. All those in favor? Post carried. Thank you. All righty. Um we are moving on to item where am I? Why is my number eight? Okay. Uh so 2025 performance appraisal of medical of health. There was one speaker on the item. Uh it was um Brook Coatsworth. Is Brook Coatsworth there? He wasn't there earlier. Is he on line? No. Okay. Uh seeing no other speakers. Uh anyone wants to speak to this item or ask questions? Seeing none, I'll move it. All those in favor? Oppose? Carried. The next item. Do you know what's the next item? A lot going on in front of me right now. Uh the next item is uh my letter in response to provincial defunding of consumption and treatment services. Uh there is one speaker on the item. Who's the speaker? Haley Thompson. Are you here online? Okay. Hi everyone. I just want to make sure that you can hear me. We can hear you. Go ahead. Great. Um thank you. Uh good morning. My or I guess good afternoon. My name is Haley Thompson and I'm the managing director of Toronto's drugchecking service uh and our provincial expansion effort Ontario's drugchecking community. Uh I want to thank uh you for the opportunity to speak today and particularly chair Moyes and Dr. Merti. Uh I'd like to thank you for highlighting the importance of our service uh and its findings on the unregulated drug supply uh and for calling on the Ministry of Health and Health Canada to ensure our program remains available uh as a critical service for people who actively use drugs. Um I also want to acknowledge that without the donation of samples from people who use drugs um in order to make the most informed health decisions uh we are not able to provide the near real-time information on the unregulated drug supply that we do that informs evidencebased responses to the ongoing toxic drug supply crisis which includes prevention, harm reduction, treatment and recovery uh and community c um safety efforts. Sorry. Um, and councelor Bravo, I also appreciate your question regarding access to our service. Um, while we are federally funded by Health Canada, uh, to prioritize people who are at highest risk of overdose, so primarily those using, um, opioids, uh, our service is available to any member of the public who uses drugs. Um, and notably, approximately 30% of people who have accessed our service uh, have never previously engaged with harm reduction services or other health services for people who use drugs. Um, so since launching in October of 2019, we've checked 20,000 samples from Toronto's unregulated drug supply. Uh, and approximately 98% of those samples were collected at supervised consumption sites. Um, when the Community Care and Recovery Act passed in December of 2024, we began seeing a drop in sample collection. Uh and once the SCI SCS site sorry closed uh presume um specifically sorry uh South Riverdale uh the Queen West site of Parkdale Queen West the works in region park uh we saw approximately a 50% reduction in sample volumes. Um we are deeply concerned about the impact that these further closures of or potential closures of Moss Park and Fred Victor will have obviously on the community um and people who use drugs as well as our ability to effectively monitor the unregulated drug supply. Um for those who may not be aware of our program, we are a national leader uh and a primary source of timely comprehensive data um on Canada's unregulated drug supply. Um and we know that things have significantly worsened since launching our service. Uh the unregulated fentanyl supply in particular um is increasingly volatile and contaminated. Um and we know that the risk of both fatal and non-fatal uh drug poisonings is real ongoing and cannot be overstated. Um services tailored to people who actively use drugs, fentanyl and opioids in particular, have never been more critical. Uh and we know that organizations like Toronto Public Health uh rely on our information to inform public health alerts and also um our data is also embedded in the Toronto opioid overdose system uh data dashboard. So again just acknowledging the critical source of information um that uh that our service provides and helps to inform Toronto Public Health. Um although our program is federally funded uh until uh the end of 2027 for now um the March 13th decision to end funding for Ontario's consumption and treatment services will inevitably inevitably affect um the effectness effectiveness of our current model. Um we are actively planning a transition. Uh however we don't have funding allocated to to support that shift. Um but despite these challenges, our very tiny team is committed to maintaining service access uh and supporting and providing real-time um publicly information on the unregulated drug supply. Um that commitment is is unwavering. Um so I just want to uh thank uh Chair Moyes for for putting this letter forward. Um and uh we appreciate Toronto Public Health's ongoing advocacy and collaboration. Uh and we welcome any direct or inkind support to help ensure uh the continued uh accessibility of our program um and supervised consumption sites uh across the city um particularly uh if uh funding is not reinstated by the province. Um so thank you again. Uh thank you so much for your deputation. Any questions for uh the deputent? Uh, saying none. You've covered a lot in your deputation here. Thank you. Um, any any questions on this item? I we've been kind of talking about it throughout this meeting, so I don't feel the need to ask any further questions. Uh, any speakers on this item? So, I'll just speak to it briefly, very briefly. So um as the deputent mentioned and as we've spoken about this throughout is that we know that the provinces uh ending the funding for the existing SCS sites which has will have and continues to have a profound negative impact on those who are most marginalized and even though many people some people who come here and debute about uh suicides substance sites they just talk about one of the things that the service that's provided there, right, is harm reduction. But there's so much more that takes place in those facilities. And I have to say that, you know, I've had the privilege of going into most of them and speaking to the staff and speaking to the clients and seeing the real work that's taking place, right? Be it for example, you know, housing referrals, mental health treatment, uh the wound care, um uh women women's care and all those things. uh and again referring people to long-term uh addictions uh facilities like detox and treatment and elsewhere. And it's also a place where people gather for community. You don't see that like when I was went to the Moss Park SCS site, they actually had a couch and a area where people actually sat down and interact, right? And you know, because again, when you're on the street, there's really a lot of unhealthy relationships and having a safe space to actually talk to people that experiencing the same things that you are and having to speak to professional that actually goes a long way. And that trust is built over time. It doesn't take place in one meeting. It takes place over, you know, sometimes months, sometimes years. And I think, you know, with the current SCS sites, we've seen that, especially in Mosark and other areas. And I know that since some of the services have closed lately, as of the last year, uh the existing sites have seen a major increase uh at their doorsteps. Street Health being one of them as well as uh uh the Moss Park SCS site. And I know the staff are feeling burnt out and overworked. And I know that you know our own team at Toronto Shelter Sport Services have try to help in the best way they can just to support the staff that are there now because again we need to make sure that everyone not just the clients that are you know in a good place but also the staff who supports them. Frontline work is hard. I used to do it for many many years. I can tell you that it's it's it's you know those who do it they deserve an award and our thanks and our praise each and every day. So one of the things that was also mentioned too is that um and we touched on a little bit is that those who suffer from addictions usually you know their majority are indigenous and and racialized and equity seeking populations. And again when we take those services away what we're saying to those who are most marginalized or in need right you don't care. matter and that is not something that I would support uh and even tolerate not only as chair of public health but just you know decent human being who lives in the city. Uh these people are part of our communities and um we need to make sure that they are well taken care of. Another issue that's been talked about too is a drug checking uh samples and it's be is through the SCS sites that we actually check the drugs. If we actually don't have SCS sites, the drugs are being checked and we know uh you know what's in the drugs have continues to change and evolve. For example, horse tranquilizers. We know that eloxone doesn't work with these things in it. And so we're putting people at risk and we're also putting our staff at risk. You know, be fire, police, paramedic when they go and attend and support those people, right? So you know we need to give everyone the tools that they need to make sure that uh you know people are well supported not just those that we are receiving care but those who are providing the care as well. And lastly, in my letter, I want to also have the board endorse the letter from the Canput Drug Policy Coalition and Drug Strategy Network of Ontario and the HIV Legal Network urging the province to cons reconsider uh the uh their decision to defund the provinially funded supervised consumption sites. So that's the gist of the letter and um I hope that uh we can get full support from this board and I do hope that the province continues will listen uh to a degree and at the very least as I've mentioned uh if they cannot continue to fund the SCS sites at least provide funding for the services that is in place to support them in other ways. So, with that, I will um move on and ask for a vote on the item. Can we put it on the screen? I assume there's no questions. Okay. All righty. All those in favor? Opposed? Carried. That's moved. And that brings us to the end of our agenda. Thank you very much for participating. Um it was a great meeting and thank you again to our new members for also being here as well. And we'll see you next time. Thank you. And thank you to staff and to the clerk's office. Thank you. Thank you.

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