(City Council on April 16, 1998, adopted this Clause, without amendment.)

The Board of Health reports having requested the Federal and Provincial Governments to ensure that ongoing funding for child nutrition programs are provided, and requests Council to endorse its action in this respect and advise the Federal and Provincial Governments accordingly.

The Board of Health reports, for the information of Council, having:

(1) received the report (March 11, 1998) from the Medical Officer of Health respecting Update on the Budget Process which recommends that this report be received for information;

(2) adopted the report (March 12, 1998) from the Medical Officer of Health respecting Investing in Public Health and in so doing:

(a) indicated its continued support for needs-based public health funding in order to maintain the health and social infrastructure of the new city;

(b) requested the Medical Officer of Health to continue to consult with public health stakeholders across the new city to identify service needs and gaps;

(c) as part of a continuing review of public health needs and levels of service across the new city, requested the Medical Officer of Health to report back to the Board of Health in the Fall of 1998 on a complementary investment strategy for public health in the following budget year; and

(d) requested that the foregoing report be forwarded to the Budget Committee, the Community and Neighbourhood Services Committee and all members of Council for information;

(3) (a) amended Recommendation (1) of the report (March 11, 1998) respecting Investing in our Children's Health by revising the requested amounts so as to read:

"(1) That the Board of Health forward to the Budget Committee for consideration of allocation of funds to Public Health totalling $2,905,100.00 on an annualized basis, including $2,045,300.00 for 1998 in operational costs and $130,000.00 in capital costs for children's health services in the City of Toronto (as per Appendix 1)"

and adopted this recommendation; and

(b) forwarded the foregoing report to the Community and Neighbourhood Services Committee and the Children's Action Committee for their consideration in the development of a children's strategy;

(4) amended the report (March 11, 1998) from the Medical Officer of Health respecting Child Nutrition Programs in Toronto by deleting Recommendation (2) therein, and in so doing:

(a) endorsed the document titled "Child Nutrition Programs in the New City of Toronto" submitted by the Toronto Community Partners for Child Nutrition, appended to the foregoing report dated March 11, 1998;

(b) requested the Medical Officer of Health to consult with the Toronto District School Board, the Toronto Catholic School Board and key stakeholders to establish a working group to oversee city wide issues relating to child nutrition programs; and

(c) forwarded the foregoing report to the Children's Action Committee, the Toronto District School Board and the Toronto Catholic School Board, and to the Budget Committee, the Neighbourhood and Community Services Committee and all members of Council for information;

(5) requested the Minister of Health to maintain her commitment for the provision of funding for food and nutrition programs;

(6) requested the Medical Officer of Health to:

(a) identify which public health programs and services would be more appropriately funded by the provincial government, and report back to the Board of Health accordingly; and

(b) prepare a chart which demonstrates in a brief and concise manner, how monies were spent in 1997 on mandatory, optional, and desirable programs across the six former municipalities in a way that easily demonstrates why the reinvestment motion adopted by the Board at its meeting on February 23, 1998 is so important in terms of the Board's mandate with respect to the unmet needs, inequities and best practices for each program in order to address the public health concerns of the citizens across the city; and

(7) requested the City Solicitor to report back to the Board on the legal requirements that must be fulfilled in order to call a fully constituted meeting of a committee, agency, board or commission of City Council.

The Board of Health submits the following report (March 11, 1998) from the Medical Officer of Health regarding child nutrition programs in Toronto:

Purpose:

This report describes the current status of Toronto's child nutrition programs, outlines key issues of concern and recommends supportive mechanisms to address them.

Source of Funds:

To be determined through the budget process.

Recommendations:

It is recommended that:

(1) The Board of Health endorse the attached document "Child Nutrition Programs in the New City of Toronto" submitted by the Toronto Community Partners for Child Nutrition;

(2) the Board of Health consider the advice of the Toronto Community Partners for Child Nutrition that $1,185,480.00 be allocated to Child Nutrition Programs to provide municipal core funding for existing child nutrition programs in the new city;

(3) Public Health collaborate with the Toronto District School Board, the Toronto Catholic School Board and key stakeholders to establish a working group to oversee city wide issues regarding child nutrition programs;

(4) this report be forwarded to the Children's Action Committee, the Toronto District School Board and the Toronto Catholic School Board; and

(5) the Board of Health and City Council communicate with the provincial and federal governments to request ongoing funding for child nutrition programs.

Background:

Beginning with only a handful of programs in 1991, more than 200 child nutrition programs are now operating across the City of Toronto, serving nutritious meals and snacks to 30,000 school children during their school day. This explosion of growth, particularly during the past three years, is a response to growing public concern about children who are not adequately nourished for optimal health and school achievement.

The need for child nutrition programs was highlighted in The First Duty Report of the Metro Task Force on Services to Young Children and Families which recommended that:

"municipal and provincial governments must make the commitment to adequately fund nutrition programs where they are needed in Metro Toronto, and provide necessary supports to ensure these programs can continue to serve children".

The Province of Ontario has recognized the need for child nourishment programs through a grants program of five million dollars during the past two years, to provide seed funding for new programs and to encourage community partnership support. Furthermore, the Ontario Ministry of Health has outlined key roles for Public Health in child nutrition programs in the recently released Mandatory Programs and Services Guidelines (see Appendix A).

Currently, public health staff provide support to these programs in most areas of the city through a range of services including program administration, development and monitoring of nutrition and food safety standards, community mobilization, staff training and fund raising. Although levels of service differ considerably across the city, the total Public Health involvement is approximately 3.5 FTE's, including public health nutritionists, dietitians, nurses, and inspectors.

Most child nutrition programs exist without organized support and dependable sources of funding. Funding for September 1998 is in serious jeopardy due to the insecurity of provincial, municipal and community funding sources. Provincial seed grants which have facilitated many Toronto program startups, are not assured for 1998 and are, in themselves, insufficient to provide program sustainability.

During the past year, a multidisciplinary group known as the Toronto Community Partners for Child Nutrition was formed. This group represents programs in all former municipalities and has met regularly to discuss issues of mutual concern. It has developed a partnership model that will ensure high quality, sustainable programs in Toronto and proposes strategies to leverage funding support from the public and private sectors. This model is attached as Appendix B and forms the basis of this report.

Comments:

The Need for Child Nutrition Programs:

A 1997 National Child Hunger Survey of 2000 Canadians estimated that 42 percent of Canadian children are not regularly eating a nutritious breakfast before going to school. Similar findings come from a 1997 Scarborough study showing that more than 35 percent of children did not have breakfast. The number of children on social assistance, another indicator of need, increased from 60,000 children (15 percent) in 1990, to 127,230 (26 percent) in 1995.

Although poverty is a key indicator of nutritional need, there is strong evidence that children from all income brackets are at nutritional risk for a variety of reasons:

(a) parents must leave early for work and are unable to ensure that the morning meal is eaten;

(b) children have to eat very early and are hungry again by school time;

(c) children as young as nine-years-old skip meals in an effort to be slim and conform to socially acceptable body image standards;

(d) children miss breakfast because of before-school extra curricular activities; and

(e) societal norms are created by adults who do not themselves eat a morning meal.

Lack of nutritious food before school affects children in two important ways. First, a morning meal contributes to both quality and quantity of the total daily intake of energy, protein, carbohydrate and micronutrients such as iron and calcium. In populations where children lack adequate nutrition, the inclusion of a nutritious morning meal may make it possible for a child to be well nourished over the long term and avoid nutritional deficiencies such as iron. Iron deficiency in children has a negative impact on attention span, cognitive development and learning ability. Iron deficiency is prevalent in Canada; from 6 percent to 12 percent of school aged children have frank iron deficiency anaemia. At least 35 percent of otherwise healthy female teenagers are iron deficient enough to impair performance.

Secondly, all children experience cognitive benefits from a morning meal, particularly in the speed and accuracy of information retrieval in working memory. Evidence of this benefit are strongest and most consistent in undernourished children. In summary, school meal programs protect children from the cumulative negative effects of missing breakfast. This is the situation with a substantial number of children in Toronto.

To meet these important health and learning needs, greater emphasis must be placed on cost effective ways to provide universal access to nutritious food for school children .

Current Status of Programs:

Most child nutrition programs in Toronto are run independently by schools or community groups, many with assistance from public health staff. In the former City of Toronto, programs are coordinated by a community committee chaired jointly by Education and Public Health representatives.

Three-quarters of programs have a paid coordinator; the remainder are run solely by volunteers. Almost all programs, however, are extremely dependent on volunteer support and from 600 - 800 volunteers are estimated to be currently involved. About 200 people are employed on a part-time basis to coordinate local programs, liaise with the community, and fund raise.

In at least two districts, many programs operate only two or three days a week because they lack funds. Ninety percent of programs are in schools, with the remainder in other community sites. The following chart provides basic information about existing child nutrition programs:

Program costs - Average cost per child is estimated at 89 cents per day, and varies from $0.45 to $1.65 according to the type of meal served and the availability of food. In some areas of the City, all of the food is donated from food banks or businesses, reducing program costs but usually sacrificing nutritional quality. Staff are all part-time, with wages ranging from small honoraria to modest hourly wages.

Funding - All of the current programs are dependent on a partnership model of funding that includes most of the following sectors:

(1) Parents - Both in-kind and financial contributions are a stated expectation of parents in the majority of programs. They provide approximately 38 percent of the funding in established programs, however the amount varies from 0 - 100 percent across the city. Parental contributions are based on ability to pay and are often negligible in high need areas.

(2) Provincial - The majority of programs have received one-time seed grants from the Province of Ontario (through the Canadian Living Foundation) for start-up funds ranging from $1000.00 to $3000.00. Continued seed funding for September 1998 has not yet been assured. While these grants are very beneficial for start-up, they do not provide sustainability.

Four of the former municipalities have received one-time grants of $15,000.00 or more to set up a Community Partners program to develop community support. These grants terminate in April 1998, leaving little or no coordinating and fund raising capability.

(3) Directed grants, corporate and community based fund raising - In most districts, programs are very dependent on this resource base. In some districts, these contributions are largely "in kind" and change on a regular basis. This greatly weakens the nutritional quality of the meals, and means that nutritious menus cannot be planned.

With city amalgamation, there is a great potential to benefit from a coordinated fund raising approach to charitable funders, corporations and service clubs. At the present time, securing these funds is extremely labour intensive, often monopolizing coordinators time, and reducing time available for quality programming.

(4) Municipal grants - Annual grants of $125,000.00 from the former City of Toronto and $350,000.00 from the Board of Education since 1991, have enabled leveraging of an additional $1M from other sources. In North York, the Board of Education provided start-up grants totalling $16,000.00 in 1997, and City Council allocated $15,000.00. Both the North York City Council and the North York Board of Education have contributed to the Toronto Children's Breakfast Clubs operating in North York for many years. All of these grants are in jeopardy because of restructuring.

Key issues to address

(1) Sustainable funding sources - Without core funding, over three quarters of existing programs report that they are in danger of closing by June 1998. Provincial funding has not been assured for 1998, and does not provide long term stability to programs.

Municipal funding, which provides core support to 40 programs in the former city of Toronto, and several in other districts, may be withdrawn. Fund raising from charities and corporations has great potential on an organized, city-wide basis, but is too variable to provide a core funding base. Core municipal funding has been proven to offer considerable security and leveraging capacity to child nutrition programs through only pennies per day per child. In the proposed funding model (see Appendix B) it is recommended that 24 percent of funding, or $1,185,480.00, should come from the municipality to provide core support for all existing programs serving 30,000 children.

(2) Food safety monitoring - Because programs are delivered by local staff and volunteers in a wide range of settings, it is critical that food safety measures are in place to prevent food borne illness. Regular program monitoring and staff training are essential in a program of this magnitude, and should be coordinated through a city wide committee.

(3) Nutrition standards - These standards are often sacrificed to keep programs going in the face of inadequate funding. Donated and food bank food cannot serve as a basis for a quality nutrition program that ensures nutritional benefits to our most valuable resource, namely children. Quality assurance must be ensured through regulation of nutrient content of menus and ongoing staff training. Appropriate curriculum and school food policies are essential supports.

(4) Need for coordination and capacity building at the district level - The provincial Community Partners program, which has funded coordinators in four former municipalities, may no longer be available, leaving many areas of the city without infrastructure to support new programs. Core funding has proven effectiveness in leveraging resources to develop this community support.

(5) Need for city-wide coordination - A new structural mechanism is required to provide city-wide coordination of quality programs, including fund raising, nutrition and food safety standards, evaluation, and equitable allocation of funding.

Conclusions:

The need for child nutrition programs for the City of Toronto is clearly established. Lack of food in the morning is known to have an adverse effect on learning and nutritional health, especially in at-risk children. Funding for the many newly formed nourishment programs is essential and cannot be adequately met by parental contributions and corporate fund raising. Considering the shifts in funding for education and health, it is essential for the Board of Health to recommend to City Council the level of municipal funding necessary to support existing programs and to advocate for matched funding from the provincial and federal governments.

Contact Name:

Carolyn Barber, Toronto office

Manager, Nutrition Services

Tel. 392-7451

Fax 392-1483

Connie Uetrecht, North York office

Director, Lifestyle Policy & Planning Division

Tel. 395-7671

Fax. 395-7691

References:

(1) Pollitt, E. 1995. Does breakfast make a difference in school? Journal of the American Dietetic Association. 95:1134-1143.

(2) McConnell, PE and Shaw, JB. 1998. Position of the American Dietetic Association: Child and adolescent food and nutrition programs. Journal of the American Dietetic Association. 96:913-922.

(3) Brown, JL and Pollitt, E. 1996. Malnutrition, Poverty and Intellectual Development. Scientific American. 274:38-43

(4) Levy, L. Eating Habits in Canada: Practical, Clinical Considerations to Identify, Treat and Manager Patients at Risk. Presented at Canadian Eating Habits: Are Your Patients at Risk? Sponsored by Whitehall Robins, November 1997.

The Board of Health reports, for the information of Council, having also had before it during consideration of the foregoing matter, the following appendices, reports and communications, copies of which are on file in the office of the City Clerk:

- (March 11, 1998) from the Medical Officer of Health forwarding an update on the budget process;

- (March 12, 1998) from the Medical Officer of Health respecting investing in public health;

- (March 11, 1998) from the Medical Officer of Health regarding investing in our children's health;

- (March 4, 1998) from the City Clerk forwarding action taken by the Etobicoke Community Council at is meeting on February 18, 1998 respecting public health services;

- Appendices A and B referred to in the report (March 11, 1998) from the Medical Officer of Health regarding child nutrition programs in Toronto;

- (March 18, 1998) from T.R. Hosier, Coordinator of Counselling Services, The Salvation Army, Maxwell Meighen Centre, Counselling Services;

- (March 10, 1998) from Mr. Norman Levine, Acting Dean, Faculty of Dentistry, University of Toronto;

- (March 10, 1998) from Sayeh M. Larasani;

- (March 16, 1998) from Dr. M.J. Weisbrod;

- (March 11, 1998) from Suntha Mohan;

- (March 11, 1998) from Ms. Andrea Stinson;

- (March 17, 1998) from Alayna Munce, Support Staff/Facilitator, Shalom House;

- (March 17, 1998) from Mr. Richard Griffith, The Always Growing Garden Project;

- (March 4, 1998) from Ms. Janice Kendal;

- (March 15, 1998) from Abina Murphy, Program Coordinator, St. Paul's Family Resource Centre;

- (March 19, 1998) from Mr. Robert K. Heyding, M.D., Leaside Health Centre;

- two communications (undated) from Ms. Karen Positano, Supervisor, Inner City YOUTH LINK;

- (March 13, 1998) from Kwong Y. Liu, Director of Social Services, Yee Hong Centre for Geriatric Care;

- (March 19, 1998) from Esedra Lasci, Patient Services Director, Mental Health, Psychiatry, Specialized Geriatrics, Maternal Newborn and Child, St. Joseph's Health Centre;

- (March 24, 1998) from Ms. Maureen Thompson, Community Health Coordinator, Regent Park Community Health Centre;

- (March 19, 1998) from Robin Edoghamhen, Program Director, Metro Street Focus Organization;

- (March 23, 1998) from an unidentified citizen;

- (March 21, 1998) from Mr. Allan Fellowes, Chair, St. George's Out of the Cold Programme;

- (March 4, 1998) from Ms. Marilyn Jacobs;

- (undated) from Kanthi Anandakumar;

- (March 23, 1998) from Pat Jensen, Executive Director, West Hill Community Services;

- (March 23, 1998) from Mr. David Smiley, Director, Harbourfront Community Centre;

- (March 23, 1998) from Evadne Wilkinson, Program Coordinator, Out of the Cold;

- (March 24, 1998) from Mr. Neil Longley, Program Manager, Homes First Society;

- (March 17, 1998) from Ms. Maureen Toms, Manager, Homes First Society;

- (March 12, 1998) from B. Cahalane, Principal, Toronto Catholic School Board;

- (March 24, 1998) from Dr. J. Rosenbloom, Queen West Community Health Centre;

- (March 23, 1998) from Ms. Denis Casey, Acting President, CUPE Local 79;

- (March 24, 1998) from Ms. Rita Luty, Chair, Northern Community Health Board, former City of Toronto;

- (undated) from Ms. Colette Murphy, Manager, Allocations and Community Services Department, United Way of Greater Toronto;

- (March 24, 1998) from Ms. Gail Nyberg, Chair of the Board, Toronto District School Board;

- (undated) from Master Matthew Knight, student, St. Martin's School;

- (undated) from Latha Sukumar, The Immigrant Women's Health Centre;

- (undated) from Mr. Michael Battista, Vice-Chair, Board of Directors, AIDS Committee of Toronto, and Mr. William Lee, Executive Director, Asian Community AIDS Services, obo Key Partners Committee;

- (undated) from Mr. Patrick Evans, Gay Men's Education Network;

- (undated) from Trung Binh Ngo;

- (March 24, 1998) from Ms. Joan Anderson, Voices of Positive Women - Women's Outreach Network;

- (March 24, 1998) from Ms. Gloria Sheppard, Older Women's Network;

- (undated) from Ms. Dorothy Hahn;

- (undated) from Ms. Debbie Field, FoodShare Toronto;

- (March 24, 1998) from Ms. Ruby Wood-Twyman, Chair, Women's Health CAP;

- (March 24, 1998) from A. Rodney-Bobiwash, Executive Director, Native Canadian Centre of Toronto;

- (March 24, 1998) from Ms. Dorothy Wheeler, Member, Citizens Concerned About Public Health;

- (undated) from Ms. Catherine Moraes, Chair, Toronto Community Partners for Child Nutrition;

- (undated) from Ms. Catherine Moher, Program Manager, The Gerrard Resource Centre; and

- (March 11, 1998) from Ms. Heather Mains, Consumer Health Consultant.

The following persons appeared before the Board of Health in connection with the foregoing matter and in connection with matters respecting investing in public health and children's health:

- Ms. C. Murphy, Manager, Allocations & Community Services, United Way of Greater Toronto;

- Ms. Rita Luty, Northern Community Health Board, former City of Toronto;

- Ms. Krista Ellis, Community House Worker, Strachan House;

- Ms. Michelle Hewton, Jessie's Centre;

- Ms. Gail Nyberg, Chair, Toronto District School Board;

- Master Matthew Knight, Student, St. Martin's School;

- Ms. Venus Carter, Healthiest Babies Possible;

- Ms. Caryl Elie, Healthiest Babies Possible;

- Ms. Carolyn Egan, Sexual Health Network;

- Latha Sukumar, Chairperson, Immigrant Women's Health Centre;

- Mr. Michael Battista, Vice-Chair, Board of Directors, AIDS Committee of Toronto;

- Mr. William Lau, Executive Director, Asian Community AIDS Services;

- Mr. Patrick Evans, Projects Coordinator, Gay Men's Education Network;

- Ms. Cheryl White, Co-Coordinator, HIV/AIDS Project, Queen West Community Health Centre;

- Ms. Fiona Nelson;

- Ms. Denise Mandlarski, Teen Sex Infoline Counsellor;

- Ms. Sandra Margerrison, Planned Parenthood of Toronto;

- Trung Binh Ngo, St. Stephen Community;

- Ms. Anabella Wainberg, Women's Residence;

- Ms. Tammy Etto, Healthiest Babies Possible;

- Mr. Maurice Adongo, Street Health;

- Ms. Stella Auyeung, Mon Sheong Home for the Aged;

- Ms. Denis Casey, CUPE Local 79;

- Ms. Cherryl McDonald, Parent for Better Beginnings;

- Ms. Dorothy Hahn, Older Women's Network;

- Mr. Lee Zaslofsky, Co-Chair, Citizens for Public Health;

- Ms. Debbie Field, FoodShare Toronto;

- Ms. Ruby Wood-Twyman, St. Michael's Women's Health CAP, and HCDP Community Consultant;

- A. R. Bobiwash, Native Canadian Centre of Toronto;

- Ms. Dorothy Wheeler;

- Ms. Catharine Moraes, Metro Community Partners, Toronto Board of Education; and

- Ms. Gloria Shephard, Health Care Issues Committee, Older Women's Network.

Respectfully submitted,

JOHN FILION,

Chair

Toronto, March 24, 1998

(Report No. 5 of The Board of Health was adopted, without amendment, by City Council on April 16, 1998.)

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