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SECTION 3: Determinants and outcomes

Economic security

Income security

1. Proportion of children living in poverty
According to the latest Census data, the proportion of children under the age of 15 living in families with incomes below LICO has decreased from about 37% (1996 Census) to 30% (2001 Census). This percentage represents 128,755 children 0-14 years.

Source: Statistics Canada, 2001 Census

Importance
For families, "income is essential, not just for securing food, clothing and shelter, but because it contributes to health and security, forming a stable base from which they can participate in their community." The Federation of Canadian Municipalities Quality of Life Report 2003Status/trends

Although the decrease in child poverty rates is significant, it needs to be put into perspective. First, there were still 128,755 children under the age of 15 living in 87,345 low-income families. Second, it is quite likely that the economic downturn resulting first from September 11, and then from SARS has negatively affected families who depend on low-paying or minimum-wage jobs in tourism, hospitality and related sectors.

It is probable that the current rate of child poverty is higher
than the Census indicates. Even more sobering is the fact that the 30% rate is still 4% higher than it was in 1990 (26%). The decrease in child poverty (from 37% to 30%) has not occurred uniformly across Toronto. Map 3 highlights the areas where child poverty has decreased by at least 20%, and those where it actually increased. Notable among the increases are areas of new development that may be affected by the cycle of family break-up and re-constitution.

While lone-parent families represent approximately 17% of all economic families (with children 0-14 years), they represent 35% of all low-income families. In fact 57.2% of all lone-parent families fall within the low-income category as opposed to less than 22% of two-parent families.

It is clear that the income gap between the children in lowest-income families and the rest of the society is growing. Social assistance rates frozen since 1995 and a minimum wage that has not changed during the same period are contributing factors to the growing gap. To illustrate the size of the gap, a special calculation of 2001 Census data was arranged to categorize families into five separate categories illustrated in the following table.

Distribution of families by income category
Income categories relative to LICO
Family type
category 1
category 2
category 3
category 4
category 5
below 50% of LICO
between 50% & 90% of LICO
within 10% above or below LICO
between 110% & 150% of LICO
above 150% of LICO
Lone-parent
28.4%
24.7%
8.7%
15.8%
22.5%
Two-parent
8.9%
9.8%
6.8%
14.6%
60.0%
All families
12.2%
12.3%
7.1%
14.8%
53.6%

The above table clearly illustrates how family composition determines different income profiles. Over 28% of all lone-parent families have incomes that are below 50% of the LICO (category 1) as compared to only 8.9% of two-parent families. Conversely, while 60% of two-parent families have incomes above the 150% level of LICO (category 5), only 22.5% of lone-parent families fall into this category. When they do, there is a significant difference in median incomes according to family type: $54,402 for lone-parent families vs. $89,666 for two-parent families.

Statistics Canada low-income cut-offs
for economic families, 2000
Family size
50% below LICO
Income cutoff
50% above LICO
2 person
(e.g. 1 adult, 1 child)
$11,482
$22,964
$33,446
3 person (e.g. 2 adults, 1 child or 1 adult, 2 children)
$14,280
$28,560
$42,840
4 person
(e.g. 2 adults, 2 children)
$17,286
$34,572
$51,858

Median Incomes
 
Lone-parent
Two-parent
All families
Lowest income group
(category 1)
$6,996
$8,023
$7,559
Highest income group
(category 5)
$54,402
$89,666

$86,844

Overall median income
$23,483
$62,777
$54,465

Another useful measure of the gap in family incomes is to calculate the gap between median incomes of the lowest and highest income groups. Overall, for the City of Toronto the gap is $82,670. However, it can only be expected that the incidence of deep poverty as well as the size of the income gap will vary greatly across the city. Map 4 presents the data for all wards.

Key issues
Following the recession of the early 1990s employment in the city grew dramatically as the economy recovered. From January 1996 to November 2003, this resulted in an additional 190,800 people working, an increase of 16.9%. Over this period, the number of full-time and part-time jobs increased by 18% and 10.5% respectively.

Growth in employment is also reflected in the unemployment rate, which fell from 10% in 1996 to 6.4% in 2000 before beginning to creep upward due to a number of global events. Taken together, the impact of these events pushed the unemployment rate to an average of 9% in 2003. Among the people experiencing the greatest impact were workers in the city's tourism and hospitality sector, a large proportion of whom are women and recent immigrants.

Despite the recent setbacks, the past seven years have seen a dramatic turnaround from the recession of the early 1990s. This is evident in both the strong growth in median family income and the large increase in average employment earnings.

The median income for all two-parent families was $65,151 and $34,709 for lone-parent families. Families with children under the age of 15 have substantially lower incomes of $62,777 and $23,483 for two-parent and lone-parent families respectively.

Over this period, both men and women returned to the labour force in substantial numbers. Participation rates climbed from a decade low of 61.2% in 1996 to 66.5% in November 2003. While female participation in the labour force continues to lag behind that of men (72% to 59%), the number of working women grew by 10.9%, an increase of 59,450 individuals compared to 1996. Meanwhile, the number of employed men increased by 131,380, a jump of 22.6%.

2. Children on social assistance
The latest available data (November 2003) shows 43,070 children under the age of 15 living in families in receipt of social assistance. Over 70% of these children live in lone-parent families, and children under the age of six form the largest group.

Source: Toronto Social Services, 2003

Children in families receiving social assistance
 
Family type
Age of children
0-5 years
6-9 years
10-14 years
Total
Lone-parent
13,505
8,661
9,252
31,418
Two-parent
4,879
3,300
3,473
11,652
Total
18,384
11,961
12,725
43,070

Importance
Monitoring the number of children whose families depend on social assistance is important for several reasons:

  1. This number represents approximately one-third of all children in low-income families and almost all of the children living in deep poverty (below 50% of LICO).
  2. Because of the City's legislated involvement with the families on social assistance, it is possible to evaluate the impact and effectiveness of programs designed to overcome or minimize the effects of child poverty.
  3. The data is available on a monthly basis, and therefore it is a reliable indicator of change and a proxy for economic security and well-being of all children in Toronto

Status/trends
Over the last several years, the number of children in families depending on social assistance has steadily decreased. However, this decline stopped in the spring of 2003 and the number of children has increased since then.

Length of stay
The end of the decline is better understood by a closer examination of data on length of stay on social assistance. While the total caseload has decreased dramatically, the decrease is notable for the group of families who have been on the caseload for less than two years. In contrast, the proportion of families who have been on the caseload for more than three years has increased sharply since January 2001. For example, the number of lone-parent families with children (all ages) on the caseload in November 2003 was 62,830, a decrease of 22,723 from January 2001. Yet the number of families who have been on the caseload for three or more years has actually increased from 21,217 to 22,849, or from 24.8% to 36.4% during the same period.

Key issues
There is no simple explanation of the troubling increase in the length of stay on social assistance. However, an increase in the unemployment rate, the dismantling of ESL programs and reduced or inadequate child care supports will all contribute to the problem. Provincial funding for child care subsidies dedicated solely to families participating in Ontario Works activities has been cut in 2003 by $1.1 million, and inflation-related cost increases will lead to further reductions unless sufficient funding is allocated by the provincial government.

3. Cost of Nutritious Food Basket
In 2003, the average weekly cost for a family of four was $118.00.

The Nutritious Food Basket (NFB) is a food costing tool that measures the cost of healthy eating by applying a standard protocol for pricing 66 food items in at least six different grocery stores using the lowest price of each food item of specific size in the store. Calculated annually by Toronto Public Health staff, it provides information on how much it costs to buy a very economical basket of food that can be used to prepare meals for a family to meet their nutritional needs.

Source: Toronto Public Health, 2003

Importance
Rising food costs can be a significant hardship for low-income residents in Toronto. For many of Toronto's families, the increasing costs of other basic necessities, particularly rent costs, leaves little if any money left for food purchases.

People who do not consume sufficient amounts of nutrients necessary for a healthy immune system, such as vitamins C and A, are more susceptible to infectious diseases.

It is particularly important for pregnant women to have an adequate diet. Poor nutrition resulting from inadequate food and nutrient intake is a major contributing factor to low-birth-weight infants. Inadequate nutrition in children can lead to iron deficiency and other nutrient deficiencies, and can retard growth.

Status/trends
The cost of a Nutritious Food Basket for a family of four is as follows:

2000
2001
2002
2003
$104.88
$117.44
$121.00
$118.00

Key issues
A key finding from the NFB survey in 2002 is that Ontario Works recipients and low-income families have experienced a 13% decrease in purchasing power for basic food items since the year 2000.

Services, supports and initiatives
Toronto Public Health offers a variety of programs and services to mitigate the negative impact of the relative cost of food to housing and other necessities. These include the Healthiest Babies Possible Program for pregnant women, the Peer Nutrition Program, and the Canadian Prenatal Nutrition Program provided in partnership with many community agencies.

Objectives/benchmarks
The objective of the Nutritious Food Basket is to monitor the cost of a nutritious basket of food annually so that the information can be used to promote and support increased access to nutritious foods.

Families and children using food banks

59,200 children used food banks in 2003.
  • The number of children in families using food banks in 2003 was 35% higher than in 1995. The number of children in families using food banks grew by 1,850 since 2002.
  • In 2003, children under 18 accounted for 36% of food bank users. Among children in families using food banks, 25% were under age 5, 46% were age 5-12 and 29% were age 13-18.
  • 29% of children using food banks go hungry at least once per month. While this reflects a decline since 2002, the number is more than double that of 1995.
  • In 2003, families were split almost evenly between two-parent and lone-parent families. Among two-parent families, 32% had three children or more. Among lone-parent families, four out of 10 had one child, while 25% had three children or more.
  • Lone-parent families as a percent of all families using food banks declined from 55.8% in 1995 to 51% in 2003. Correspondingly, the percentage for two-parent families grew from 44.2% in 1995 to 49% in 2003.
  • A troubling trend is the increase in households with at least one parent/household head working in paid employment. In 2003, 26.9% of food bank households with kids where one adult worked in paid employment also had a second adult in the paid labour force. While it has previously been assumed that a job is the quickest route out of poverty (and food banks), it's clear that the hours and wages of today's low-income jobs are inadequate to meet basic living costs, especially given the context of skyrocketing rents in the GTA over the past eight years.

Source: Daily Bread Food Bank Survey of Users, 2003

Parental supports

4. Supply of licensed child care spaces
Since the beginning of 2000, the number of licensed, centre-based child care spaces grew by 11% or 4,528 spaces to 45,854 at the end of 2003. While some of this growth appears to have been a result of expanded capacity of existing operations, there has been a net increase of 61 child care centres, a majority of them operated by non-profit organizations.

Source: Toronto Children's Services, 2003

Importance
An adequate supply of affordable, stable and quality child care is one of the necessary factors in enabling the economic well-being of families. Yet, over the last several years, child care has become less affordable and some indicators point to decreasing quality as well. It is more and more obvious that only families with substantial incomes or low-income families who qualify for government subsidy (and who are not on the subsidy waiting list) can afford to place their children in a licensed child care setting.

Status/trends

Supply of licensed group child care spaces 2000 - 2003
Auspice
2000
2003
Change
Centres
Capacity
Centres
Capacity
Centres
Capacity
Commercial
181
10,586
198
12,173
17
1,587
Non-profit
525
27,736
570
30,685
45
2,949
Public
58
3,004
57
2,996
(1)
(8)
Total
764
41,326
825
45,854
61
4,528

Centres providing care for subsidized children
Auspice
2000
2003
Change
Centres
Capacity
Centres
Capacity
Centres
Capacity
Commercial
116
8,032
119
8,674
3
642
Non-profit
391
22,221
414
24,156
23
1,935
Public
58
3,004
57
2,996
(1)
(8)
Total
565
33,257
590
35,826
25
2,569

Key issues
Child care centres with purchase of service contracts represent 71.5% of all the centres and 78.1% of licensed spaces. Many of the new operators have chosen not to enter into a contract with the City of Toronto to provide subsidized child care. Since some areas of the city have more than their equitable share of subsidies, the City's Child Care Service Plan indicated against additional purchase of service contracts. Licensed spaces for school-age children were the single largest category of growth. This appears to be the result of the elimination of alternative after school programs due to cutbacks in various service sectors.

In addition to licensed group child care centres, 23 supervised home child care agencies provide care for an estimated 4,100 children. Twelve of these agencies, including one directly operated by the City, with a total capacity of approximately 3,100 children, provide care to subsidized children.

5. Access to child care subsidies
Most child care spaces receive some form of government funding. Of the total 825 child care centres, 590 receive funding for subsidized children, and an additional 129 receive wage subsidies or pay equity payments.

Source: Toronto Children's Services, 2003

Importance
Please refer to supply of licensed child care spaces

Status/trends

Child care subsidies, 1999 - 2003
 
1999
2000
2001
2002
2003
Budgeted subsidies*
24,216
24,216
24,216
24,496
22,720
Provincial/municipal cost shared subsidies
24,216
24,096
23,829
22,600
21,525
Difference between budgeted and cost shared
0
120
387
1,896
1,195
NCB supplement reserve fund
0
0
0
280
280
Social assistance stabilization reserve fund
0
0
0
0
40
100% city funded from tax base
0
0
0
0
375
Unfunded subsidies
0
120
387
1,616
500
* excluding annually budgeted expansion of 2,000 subsidies

Key issues
In addition to the funding dedicated to child care subsidies, the City of Toronto provides additional financial supports such as rents paid on behalf of centres located in schools, and minor capital funding to improve playgrounds and to correct situations threatening the health and safety of children and staff by lowering the cost to the user. These investments, which range between $6 and $10 million annually benefit all families using child care, regardless of whether they pay "full" fees or receive child care subsidy.

Even with these supports, many families cannot afford the cost of care. For example, the average public fee for an infant space has climbed by 13.3% since 2000 to $54.08. In some areas of Toronto the going rate for a licensed infant space is as much as $75.00 per day (see map 6). In supervised home child care settings, the cost of care for a child under two is approximately $31.00 per day, while a recent survey of informal child care costs found rates as high as $56.00 per day in some of the more affluent areas of Toronto.

A decreasing number of child care subsidies is available only to a small portion of families who are potentially eligible. Since a peak of $143.7 million in 1999, the amount of provincial funding dedicated to subsidized child care has decreased to $131.1 million in 2003. Cost-shared subsidy spaces have declined from 24,216 to 21,525 in 2003 and the City of Toronto has allocated additional funding to protect up to 1,195 subsidies from elimination in the same year.

Access to subsidies is also being limited by the policies implemented by the previous provincial government which affect eligibility for fee assistance. These policies include a restriction on hours of care a child can receive, definition of student loans as income, restricted access to child care while looking for work and others.

For many families, especially families consisting of a single caregiver, these policies represent a real barrier to meeting their economic and educational goals and fulfilling their potential. Although the current waiting list stands at 7,500 eligible children, a similar number have been withdrawn from the active waiting list due to their parents' inability to meet the stringent eligibility criteria. For child care providers, these policies represent increases in: turnover in clients, vacancies and administrative effort. Finally, none of these policies can be justified as having in mind the best interest of children.

Lone-parent families use over 77% of all subsidies. The majority of families receive subsidies because parents are employed (63.3%) or are full-time students (23.8%); 1,276 children (5.7%) receive subsidized child care because of their, or their parents' special needs.

Spaces in centres with/without subsidy contracts
(for a larger view, please click on chart)

Stable, affordable housing

6. Affordable housing
In 2001, approximately 70,000 families with children (of all ages) in the City of Toronto paid more than 30% of their income on rent. As of September 2003, there were 20,846 families with dependents on the active waiting list for subsidized housing in Toronto. Most of these households are either surviving on low wages or fixed income such as social assistance benefits or pensions.

Source: Statistics Canada 2001 Census
Toronto Community Housing Corporation,
Toronto Social Housing Connections

A measure of affordability of rental housing is the proportion of income that is spent on housing costs. For tenants, affordable housing cost is defined as rent that is less than 30% of the total household income. Tenant households who pay more than 30% of their income for rent may be facing housing affordability issues.

Importance
"Having a secure source of housing is widely regarded as a stepping stone for gaining and maintaining employment, for providing a secure and supportive environment for raising children, and for accessing key public services such as health, education and social services."-Canadian Housing Observer 2003

Status/trends
Toronto's vacancy rate has risen to unexpected levels. In October 2003, the vacancy rate in Toronto was 3.9% and the average rent for a two-bedroom apartment was $1,045. Between 1997 and 2003, the average rent in Toronto rose by 28%.

2003 average apartment rents in City of Toronto
Bachelor
1-bedroom
2-bedroom
3 bedroom +
All units
$734
$884
$1,045
$1,225
$961

Although there are more housing units available for rent, the market conditions are not meeting the needs of low-income families with children. The supply of less expensive apartments (rents under $800) has decreased from 65% in 1996 to about 20% of the market today.

Social housing accounts for the majority of less expensive rental housing in Toronto (renting at $500 a month or less). In 2002, there were 108,000 units of social and other assisted housing in Toronto, of which approximately 43,000 (or 41%) were family units. The demand for social housing continues to rise. Since 1998, the number of applications for social housing has risen from 49,122 in January 1998 to 73,143 in September 2003, an increase of 49%.

Families in receipt of social assistance are particularly affected by the high cost of rent in Toronto. Eighty percent of Ontario Works clients live in private market housing. In February 2003, 70% of Ontario Works households paid rent in excess of the maximum shelter component of their benefits. The problem is especially acute among two-parent families with children, who on average paid rents in excess of their maximum shelter allowance by $302 each month (note: the shelter allowance component of Ontario Works benefits for a two-parent family with two children over the age of 12 is $602 and the basic needs allowance is $648 for a total of $1,250).

Tenants with limited incomes often have to struggle between making rent payments and providing food and other necessities for their families. This results in a rise in the use of food relief programs such as food banks.

Between 2000 and 2002, there have been only 240 new purpose-built rental units. The annual average of less than 300 units built in the three-year period fell far short of the Homelessness Action Task Force's target of 2,000 new affordable units each year to keep pace with growth in demand.

Key issues
The shortage of affordable housing in Toronto is largely the cumulative result of public policy decisions, including government funding cuts and new rent regulations. In 1993, the federal government withdrew its funding for new social housing, followed shortly by the Ontario government in 1995. In 1995, the Province of Ontario cut social assistance benefits by 21.6% and in 1998 rent controls were lifted on vacant rental units in the private sector. These actions have left many people struggling to find and keep their housing with less income in a private rental market prone to rising rents.

Services, supports and initiatives
Resolving Toronto's affordable housing shortage requires help from all levels of government. To date, some new affordable housing have been built as a result of a number of government-funded programs. These are:

  (a) the City of Toronto's Let's Build Program, which provides municipal resources (including capital funding and land) to community-based groups to develop affordable housing.
  (b) the federal Supporting Communities Partnership Initiative (SCPI) program, which provides funding to develop transitional housing for the people.
By late 2003, 493 new affordable units and an additional 561 transitional housing units were under development through Let's Build and the SCPI program. About 330 families with children will be housed in these new units.
  (c) Provincial "New Tomorrow" rent supplement program, which supplements the difference between the market rent and the subsidized rent that the tenant can afford, to help tenants secure permanent housing. To date, funding for 1,841 units has been committed to various agencies including 692 units being developed under the Let's Build and SCPI programs, mostly family units. When the new rent supplement program is fully implemented, it will assist about 2,500 tenant or homeless households.
  (d) Federal National Affordable Housing Program, which provides $680 million over five years, and requires matching contributions from provinces and municipalities. Federal-provincial funding has been committed to the City of Toronto to develop 1,000 rental housing units, resulting in Council approval for the construction of 904 new affordable units, which will include 334 units for families with children. It is estimated that an additional 3,000 affordable units will be developed over the next three to four years under this funding source.

Objectives/benchmarks
Increasing the supply of affordable rental housing is one of the keys to addressing the housing and homelessness crisis. The Mayor's Homelessness Action Task Force set an annual development target of 2,000 new affordable rental units to keep pace with growth in demand.

7. Homelessness
Homelessness continues to be the most visible indication of the affordable housing crisis. In 2002, approximately 15% (3,752) of households staying in an emergency shelter were families, including 4,779 children. One-third of these children were under the age of four and more than half were school-aged (5-14 years).

For families, the main reason they need emergency shelters on a repeat basis is eviction.

Source:

City of Toronto Shelter, Housing and Support
DivisionStatistics Canada, 2001 Census
Ontario Rental Housing Tribunal

Importance
The stress associated with housing instability and being homeless can negatively affect a child's development. Of particular concern are:

  • damage to developmental, psychological and social growth
  • poor health and nutrition
  • academic difficulties.

Status/trends
The demand for shelters from two-parent families grew steadily from 1990 to 2001. However, between 2001 and 2002, the number of two-parent families staying in shelters dropped from 2,141 to 1,417 (a decline of 51%). In contrast, the number of single-parent family users continued to increase. In 2002, approximately 2,300 single-parent families used shelters, an increase of 200 from 2001.

This dramatic decline in the number of two-parent families was largely due to more restrictive federal immigration policies on the number of refugees and other newcomers seeking temporary shelter upon their arrival in Canada.

In addition, support services such as the Central Family Intake program helped divert families from the shelter system and keep them housed instead.

As a result of the overall decline in the number of two-parent family users, the number of children staying in shelters dropped sharply from 6,727 in 2001 to 4,779 in 2002.

Key issues
Despite the economic growth in the past year, the two main causes of homelessness, poverty and shortage of affordable housing remain serious problems in the city.

Tenant households who have affordability problems (i.e., pay more than 30% of income on rent) are vulnerable to losing their homes due to rent arrears. About 80% of applications for eviction filed by landlords are because of rent arrears (Ontario Rental Housing Tribunal). Some of the people evicted become homeless and turn to the shelter system for assistance. In 2002, 17% of the requests for shelter that were made to the Central Family Intake telephone line of the City's shelter system were due to evictions by landlords.

Services, supports and initiatives
The City is directing more resources to prevent homelessness and help people find affordable rental housing. Provincial and municipal funding is allocated to a range of community-based prevention programs every year to prevent evictions, help people find appropriate housing and help them to stabilize their lives so they are less vulnerable to losing their homes.

  • Help to prevent evictions:
    In the first quarter of 2003, City-funded agencies worked with 2,405 households in Toronto who were at serious risk of eviction. Approximately 34% (or 817 households) were either single-parent or two-parent families.

The agencies were successful in preventing evictions in many situations, 1,760 in the first quarter of this year alone.

  • Help to find affordable housing:
    In the first quarter of 2003, housing help services assisted over 8,000 households in their search for permanent and affordable housing. Approximately 1,600 of these households were lone-parent families. Overall, about 60% of the 8,000 households were able to find housing.

Through the Federal Supporting Communities Partnership Initiative (SCPI), the City also funds community-based agencies to assist people who are homeless or at high risk of becoming homeless. While most programs are provided to the general homeless population, a number of programs are either specifically targeted to children and families or have a significant proportion of families/children in their clientele.

These programs include:
  • Kid Builders Project of the Aisling Discoveries Child and Family Centre developed a therapeutic group approach for children living in emergency shelters to foster hope, resilience and coping strategies. More than 80 children in two family shelters were assisted over an eight-month period between November 2001 and June 2002.
  • Partners for Access and Identification (PAID) Program operates regular weekly identification clinics at 49 sites across the city to help homeless people secure personal identification documents to connect with necessary services such as health care, shelter, housing, food, mental health services, employment and other income support programs. During the first six months of 2003, the project assisted 8,776 households and 57% of these were families with children.
  • To prevent homelessness, the Fort York Food Bank provides advocacy, counselling, peer support and outreach for individuals and families who visit the food bank, particularly immigrants and refugees for whom English is not a first language. In the twelve-month period ending March 31, 2003, 2,498 clients used the Food Bank and 632 (25%) of these were children.
  • The First Contact Program of the Canadian Red Cross assists homeless refugee claimants by providing a 24-hour, seven-day a week telephone hotline and settlement services. The services include: referrals to shelter and other appropriate services, and a drop-in space for computer and telephone access. In the twelve-month period between October 2002 and September 2003, 108 children and 78 families were assisted by this program out of a total of 645 individuals and households.

In addition, most shelters in Toronto have a range of supports to help people find appropriate housing and get re-established in the community. Shelter workers link people to health and social services, employment and education resources, and provide follow-up support to help people stabilize in the community so that they are less likely to return to the shelter system.

Objectives/benchmarks
In the absence of substantial affordable housing development, the City must ensure that sufficient emergency shelter beds are in place to meet the needs of homeless people. In 2002, the City developed a Multi-Year Shelter Strategy, which sets out future development targets for shelters. Priorities under the strategy include implementing new shelter standards, improving shelter access across the city and addressing the sustainability of shelter funding. The City also adopted a new set of Shelter Standards, which outline the standards of organization, access to shelter, resident rights and responsibilities, program standards, food safety and nutrition standards, health and safety standards, and expectations for staff training.

Section 3: Determinants & outcomes: Health

 

 
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