Public Health 2000 Budget Submission - Public Health
Research Education and Development (PHRED)
Interim Program Re-Establishment
The Policy and Finance Committee recommends the adoption of the Recommendations of the Budget Advisory
Committee embodied in the following communication (December 10, 1999) from the City Clerk:
Recommendations:
The Budget Advisory Committee on December 9, 1999, recommended to the Policy and Finance Committee, and Council,
that:
(a) the Public Health Research Education and Development (PHRED) Interim Program Re-establishment be supported;
and that the Commissioner of Community Services and the Medical Officer of Health request 100 percent funding for this
Program from the Province; and
(b) the report (November 10, 1999) from the City Clerk, entitled "Public Health 2000 Budget submission - Public Health
Research Education and Development (PHRED) - Interim Re-establishment", be deferred for consideration during the
2000 Operating Budget process.
Background:
The Budget Advisory Committee had before it a communication (November 10, 1999) from the City Clerk, advising that
the Policy and Finance Committee on November 10, 1999, referred the communication (October 18, 1999) from the City
Clerk, entitled "Public Health 2000 Budget Submission, Public Health Research Education and Development (PHRED)
Interim Program Re-establishment", to the Budget Advisory Committee for consideration and report thereon to the Policy
and Finance Committee.
_________
(Communication dated November 10, 1999, addressed
to the Budget Advisory Committee
from the City Clerk)
The Policy and Finance Committee on November 10, 1999, referred the communication (October 18, 1999) from the City
Clerk, entitled "Public Health 2000 Budget Submission, Public Health Research Education and Development (PHRED)
Interim Program Re-establishment", to the Budget Advisory Committee for consideration and report thereon to the Policy
and Finance Committee.
Background:
The Policy and Finance Committee on November 10, 1999, had before it a communication (October 18, 1999) from the
City Clerk, advising that the Board of Health on October 18, 1999:
(1) adopted the following reports from the Medical Officer of Health respecting the Public Health 2000 Operating Plan and
Budget, and referred such reports to the Policy and Finance Committee and the Budget Advisory Committee for
consideration during the year 2000 Operating Budget process:
(a) (October 15, 1999) entitled "Public Health 2000 Budget Submission";
(b) (October 15, 1999) entitled "PHRED Budget Interim Re-establishment";
(c) (October 6, 1999) entitled "Resources Required for Transfer of the Youth Mentoring Program to Toronto Public
Health"; and
(d) (October 15, 1999) entitled "Hot Weather Response Plan Update"; and
(2) recommended that, with respect to the Public Health Research Education and Development (PHRED) program:
(a) Public Health be authorized to spend $35,000.00 in 1999, using funds already existing in Public Health's 1999
Operating Budget;
(b) prior approval be obtained for funding from the year 2000 Operating Budget in the amount of $129,132.00 gross
($64,566.00 net) to be spent between January and April 2000, to contract short-term staff and implement a partial PHRED
program; and
(c) any additional funding for the PHRED program be considered through the year 2000 budget process.
_________
(Report dated October 18, 1999, addressed
to the Policy and Finance Committee
from the City Clerk)
Recommendations:
The Board of Health:
(1) reports having adopted the following reports from the Medical Officer of Health respecting the Public Health 2000
Operating Plan and Budget, and having referred such reports to the Policy and Finance Committee and the Budget
Advisory Committee for consideration during the year 2000 Operating Budget process:
(a) (October 15, 1999) entitled "Public Health 2000 Budget Submission";
(b) (October 15, 1999) entitled "PHRED Budget Interim Re-establishment";
(c) (October 6, 1999) entitled "Resources Required for Transfer of the Youth Mentoring Program to Toronto Public
Health"; and
(d) (October 15, 1999) entitled "Hot Weather Response Plan Update"; and
(2) recommends, with respect to the Public Health Research Education and Development (PHRED) program, that:
(a) Public Health be authorized to spend $35,000.00 in 1999, using funds already existing in Public Health's 1999
Operating Budget;
(b) prior approval be obtained for funding from the year 2000 Operating Budget in the amount of $129,132.00 gross
($64,566.00 net) to be spent between January and April 2000, to contract short-term staff and implement a partial PHRED
program; and
(c) any additional funding for the PHRED program be considered through the year 2000 budget process.
Background:
The Board of Health, at its meeting on October 18, 1999, had before it the following reports related to the Public Health
2000 budget:
(a) (October 15, 1999) from the Medical Officer of Health, recommending that:
(1) the Board of Health adopt the Preliminary 2000 Operating Plan and Budget and the 2000-2004 Capital Works Program
submissions and forward these to the Policy and Finance Committee and to the Children and Youth Action Committee for
consideration, subject to the Finance Department's review of these estimates, including the following enhancements:
(a) annualization of the costs of harmonizing the TB Control, Food Safety and Needle Exchange programs at the service
levels approved by Council in 1999, totalling $803,300.00 (net);
(b) enhancement of the following Mandatory Programs (or components thereof), including:
(i) the Child Nutrition Program $33,400.00 (net);
(ii) the Control of Infectious Diseases/Infection Control Program $256,700.00 (net);
(iii) the Emergency Planning and Response Program $19,000.00 (net); and
(iv) the Raccoon Rabies Contingency Plan $125,000.00 (net);
(c) operating funds for Council directed initiatives related to:
(i) inspection of retirement and lodging homes $257,500.00 (net);
(ii) promotion of the Environmental Tobacco Smoke (ETS) By-law $250,000.00 (net);
(iii) the One on One Mentoring Program $43,700.00 (net); and
(iv) the Hot Weather Response Plan $150,000.00 (net);
(d) re-establishment of the PHRED program $314,000.00 (net); and
(e) enhancement of information technology for operating support $493,000.00 (net) and capital expenditures $936,000.00;
and that the financial implications of this report be considered by the Budget Advisory Committee as part of the Year 2000
budget process;
(2) the Medical Officer of Health, in consultation with the Commissioner of Urban Planning and Development Services,
report back to the Board of Health and the Planning and Transportation Committee on options for generating additional
revenue related to Public Health inspection services;
(3) the Board of Health, in collaboration with the Association of Municipalities of Ontario (AMO), seek 100 percent
provincial funding for the Public Health Research and Education Development Program; and
(4) the Board of Health request the Acting Commissioner of Corporate Services to address the Information Technology
system and support needs identified by Public Health as a priority;
(b) (October 7, 1999) from the Chair, Board of Health Budget Sub-Committee, advising for the information of the Board of
Health, that the Budget Sub-Committee of the Board at its meeting on September 30, 1999:
(1) directed Public Health staff to present the capital and operating budget requests for the Public Health Division to the
Board for consideration at its October 18, 1999, meeting;
(2) deemed capital and operating budget request for information technology resources to be a high priority; and
(3) requested Public Health staff to explore the possibility of obtaining cost savings from within the department, and from
raising revenue through personal service delivery and the inspection of licensing facilities by the Public Health Division;
(c) (October 6, 1999) from the Medical Officer of Health, respecting the implementation of the transfer of the Youth
Mentoring Program from the Healthy City Office to Toronto Public Health and the expansion of the program City-wide;
and recommending that:
(1) the Board of Health support the addition of $43,745.00 for 2000 and $82,490.00 for 2001, to cover one FTE staff
position for the One on One Mentoring Program and that these monies be added to the base operating budget of Public
Health; and
(2) this report be forwarded to the Children and Youth Action Committee for their information and endorsement;
(d) (October 15, 1999) from the Medical Officer of Health, recommending that:
(1) the Board of Health endorse the addition of $150,000.00 in the year 2000 Operating Budget for Public Health to cover
the cost of the corporate Hot Weather Response Plan; the approval of this project is subject to further consideration by the
Budget Sub-Committee as part of the 2000 Operating Budget process; and
(2) the Medical Officer of Health report to the Board of Health and Council the results of the summer alerts in the fall of
2000.
The Board of Health also had before it a report (October 15, 1999) from the Medical Officer of Health, recommending that:
(1) the Board of Health endorse the re-establishment of the Toronto PHRED program with a funding arrangement for 50
percent of the program budget to be funded by the Ministry of Health;
(2) the Board of Health request that the Policy and Finance Committee authorize Public Health to spend $35,000.00 in
1999, using funds already existing in Public Health's Operating Budget, and $129,132.00 gross ($64,566.00 net) between
January and April 2000 to contract short-term staff and implement a partial PHRED program, pending final Council
approval of the 2000 Operating Budget; and
(3) the Board of Health, in collaboration with the Association of Municipalities of Ontario (AMO), seek 100 percent
provincial funding for the PHRED program.
Dr. Sheela Basrur, Medical Officer of Health, gave a presentation to the Board of Health in connection with the Public
Health 2000 Budget.
_________
(Report dated October 15, 1999, addressed to the
Board of Health from the Medical Officer of Health,
entitled " Public Health 2000 Budget Submission".)
Purpose:
This report will identify pressures on the base operating budget for Toronto Public Health in 2000, present the Public
Health 2000 Capital Budget requirements, and outline the need for additional resources required for Public Health to meet
mandatory requirements in specified priority program areas.
Financial Implications:
The annualized impacts of 1999 (or prior years) approval on the 2000 Operating Plan and Budget are estimated to be $2.6
million (gross) and $1.5 million (net). Service expansions will result in a gross increase of $5.0 million (gross) and $0.3
million (net). A majority of these expansions will be 100 percent funded by the Ministry of Health. Public Health will be
seeking additional funding of $1.0 million (gross) and $0.5 million (net) for information technology and initiatives to
address high priority gaps in the fulfillment of mandatory health programs. The total 2000 Operating Plan and Budget for
Public Health is estimated to be $120.4 million (gross), and $55.9 million (net); a net increase of 4.3 percent. The
2000-2004 Capital Works Plan has been submitted with a cash flow of $0.9 million (Appendix "A").
Recommendations:
It is recommended that:
(1) the Board of Health adopt the Preliminary 2000 Operating Plan and Budget and the 2000-2004 Capital Works Program
submissions and forward these to the Policy and Finance Committee and to the Children and Youth Action Committee for
consideration, subject to Finance Department's review of these estimates, including the following enhancements:
(a) annualization of the costs of harmonizing the TB Control, Food Safety and Needle Exchange programs at the service
levels approved by Council in 1999, totalling $803,300.00 (net);
(b) enhancement of the following Mandatory Programs (or components thereof), including:
(i) the Child Nutrition Program $33,400.00 (net);
(ii) the Control of Infectious Diseases/Infection Control Program $256,700.00 (net);
(iii) the Emergency Planning and Response Program $19,000.00 (net); and
(iv) the Raccoon Rabies Contingency Plan $125,000.00 (net);
(c) operating funds for Council directed initiatives related to:
(i) inspection of retirement and lodging homes $257,500.00 (net);
(ii) promotion of the Environmental Tobacco Smoke (ETS) By-law $250,000.00 (net);
(iii) the One on One Mentoring Program $43,700.00 (net); and
(iv) the Hot Weather Response Plan $150,000.00 (net);
(d) replacement of the PHRED program $314,000.00 (net); and
(e) enhancement of information technology for operating support $493,000.00 (net) and capital expenditures $936,000.00;
and that the financial implications of this report be considered by the Budget Advisory Committee as part of the year 2000
budget process;
(2) the Medical Officer of Health, in consultation with the Acting Commissioner of Urban Development Services, report
back to the Board of Health and the Planning and Transportation Committee on options for generating additional revenue
related to Public Health inspection services;
(3) the Board of Health, in collaboration with the Association of Municipalities of Ontario (AMO), seek 100 percent
provincial funding for the Public Health Research and Education Development Program; and
(4) the Board of Health request the Commissioner of Corporate Services to address the Information Technology system and
support needs identified by Public Health as a priority.
Background:
Public Health programs have been impacted by growing health needs and the combined effects of amalgamation,
provincial downloading and new mandatory provincial public health standards that are more detailed and prescriptive than
previous guidelines. As of January 1998, Public Health programs were to be totally funded by the municipality after being
downloaded by the provincial government. However, in March 1999, the provincial government announced its intention to
cost-share mandatory public health programs and services 50-50 with local municipalities.
Legally under the Health Protection and Promotion Act (Part II, Section 5), local Boards of Health must provide, or ensure
the provision of, a minimum level of public health programs and services in specified areas. In 1998, the Ministry of
Health published new Mandatory Health Programs and Services Guidelines. These establish minimum requirements for
those public health programs which are considered fundamental for all communities. In addition, Boards of Health are
mandated to deliver additional programs and services in response to local needs which are approved by local City Council,
as outlined in Section (9) of the Health Protection and Promotion Act. The Ministry of Health has established monitoring
and assessment indicators for each of the mandatory programs and all Boards of Health must report on compliance to the
Ministry of Health on a regular basis.
Comments:
Toronto Public Health is operating in an environment of unprecedented need and demand for services in a climate of
reduced government funding for a whole range of health, social, education, housing and environmental protection services.
This has a major impact on the health of the City overall. Public Health must respond to the health needs of the growing
numbers of seniors, single parents, new immigrants/refugees and people with low income living in Toronto as well as new
and emerging diseases. The substantial and predictable threats to long-term health that are a consequence of poverty
require that Public Health continue to make those most vulnerable a priority, in addition to addressing the health of the
entire population.
Toronto Public Health has recently completed the divisional Strategic Planning process. The vision for the Division, as
approved by the Board of Health at its meeting on July 22, 1999, is "Our Toronto will be the healthiest city possible, where
all people enjoy the highest achievable level of health". The plan includes guiding principles, goals and strategic directions
to ensure that the Division's programs and services are effective, efficient and responsive to the health needs of all people
in Toronto and to move the Division towards achieving its vision. The Division is also in the process of business planning
for programs.
Budget Pressures:
Public Health has identified the resources and programs required over the next three years to meet mandatory requirements
and to begin to address identified local needs. This report covers the 2000 Operating Budget for the Division.
Public Health staff will continue to investigate the potential for generating additional revenue from Animal Services and
selected inspection services to address some of the budget pressures. In addition, staff will continue to seek private sector
funding from local businesses, service clubs and charitable foundations for specific programs like Child Nutrition and One
on One Mentoring, and to support revenue generating partnerships such as the Toronto Cancer Prevention Coalition. Staff
are participating in the City's Corporate Sponsorship planning process with a view to further enhancing resources.
Preliminary research conducted by Toronto Public Health indicates that other neighbouring health units have achieved base
budget increases ranging from 17 percent (Hamilton) to 49 percent (York Region) to meet the new mandatory health
requirements. Toronto Public Health is, therefore, not alone in facing major budget pressures to fulfill these requirements.
A preliminary review of the Mandatory Programs and Services Guidelines conducted by Public Health staff in 1998,
indicated that all Public Health programs would require changes or enhancements to bring them into compliance with
provincial standards. While full compliance is a goal of Toronto Public Health, achievement of this goal carries substantial
budget implications. A preliminary estimate to achieve full compliance is $20.5 million annually.
(1) Annualized Impact of Council Directed Initiatives:
There were a number of program harmonizations approved by Council in 1999 that create annualized pressures on the base
Operating Budget of Public Health for 2000, resulting in a net increase of $1.5 million. This represents a 2.8 percent
increase from the 1999 approved Operating Budget. A total of $803,300.00 (net) is a result of the annualized impact of
program harmonization for Food Safety ($346,100.00), tuberculosis control ($343,000.00) and needle exchange for HIV
prevention ($114,200.00). As well, additional funds will be added to the base budget for the following Council approved
initiatives: $257,500.00 (net) for inspection of retirement and lodging homes combined with a complaints hotline;
$250,000.00 (net) for communication and public education to support implementation of the Environmental Tobacco
Smoke (ETS) by-law for 2000; $43,700.00 (net) to cover six months expenses for implementing the One on One
Mentoring program for youth at risk; and $150,000.00 (net) for the Hot Weather Response Program. These initiatives are
further outlined below.
Retirement and Lodging Homes:
The budget for the Retirement and Lodging Homes initiative covers three months of staff salaries for 2000. This is a
continuation of the inspections and hot-line initiated in October 1999. Additional budget requirements will be determined
by the recommendations of the Retirement and Lodging Homes Advisory Committee when they report to the Community
Services Committee and Board of Health in December 1999.
Environmental Tobacco Smoke (ETS) By-law:
The $250,000.00 (net) for the ETS by-law implementation represents non-staff costs for communication and a public
education campaign to support implementation of the new non-smoking by-law approved by City Council in July 1999.
Public Health will require these monies on an annual basis for continued public education and by-law promotion into 2004
and beyond. In 2001, once the by-law comes into full effect for restaurants, the Division will require time-limited
additional staffing to administer and enforce the by-law.
One on One Mentoring:
Toronto Public Health will require one full-time staff person and modest program supports at a net cost of $43,700.00 (net)
to implement the One on One Mentoring program for youth at risk, to ensure the program is available through at least one
school in each of the former municipalities. This program currently operates primarily through volunteer time from City
staff and the Rotary Club within the former City of Toronto. One additional staff person would provide support to an
expanded number of volunteers from City staff (from all areas of the City) and make possible the involvement of Rotary
Club volunteers from other former municipalities as well as seek additional private sector support for the program.
Hot Weather Response Plan:
Public Health is coordinating a corporate Hot Weather Response Plan that involves a number of City of Toronto divisions
and key community stakeholders. Since this Council initiative began only in 1999, there is currently insufficient
information to enable each division to submit a detailed operating budget for the plan. It is, therefore, recommended that
$150,000.00 be allocated to the 2000 Public Health base budget for the corporate Hot Weather Response initiative. Once a
detailed protocol has been developed, with clear heat warning thresholds and specific divisional roles identified, the budget
requirements for 2001 and beyond will be reassessed.
(2) Service Expansions/Enhancements:
Re-establishment of Public Health Research Education and Development (PHRED):
The PHRED program, previously known as the Teaching Health Unit program, improves public health practice through
applied research (e.g., benchmarking, effective practice assessments), education of public health students and practitioners,
and access to research literature for on-going program improvement. Toronto is one of six PHRED sites in Ontario.
Historically PHRED was 100 percent provincially funded. During 1998 and 1999, Toronto Public Health reduced its
PHRED program from $2.6 million to $844,046.00 in anticipation of provincial funding being eliminated. In March 1999,
the Province announced 50/50 cost-sharing of Public Health, but details of the provincial allocations for PHRED were not
available prior to Council's adoption of the 1999 budget. The Budget Committee was informed at its meeting of March 26,
1999, that current municipal funding is lower than the amount available from the Province, and that securing the full
provincial subsidy would require an increase in this program budget.
Unlike other cost-shared funding, the PHRED budget functions as matching funding where the provincial contribution
supports provincial activities and the municipal contribution supports local activities. In the same March 1999 report,
Public Health informed the Budget Committee that the remaining $844,046.00 budget initially designated for the PHRED
program is required entirely for local fulfillment of other mandatory program requirements (e.g., program planning and
evaluation, community health status information). Thus, this funding does not allow us to meet required provincial
commitments. In fact, utilizing the PHRED budget to fund the staff positions that make up the $844,046.00 reflects
Toronto's previous maximization of 100 percent provincial funding to pay for basic health unit functions. In 1999, these
staff were reassigned away from provincial and university commitments to assist with strategic business planning and
operational planning; redesign of programs to ensure harmonized serviced delivery and new mandated requirements in the
context of local need; and staff training and development to provide adjusted services.
PHRED research findings have resulted in positive changes to provincial programs (e.g., Healthy Babies lay visitors) and
local program delivery (e.g., food safety protocols). The PHRED program has drawn external grants and provincial revenue
to Toronto (e.g., new funding for post-partum home visiting). Re-establishing a PHRED program similar to Toronto's
previous program will improve program evaluation and applied research (especially in environmental health, dental health,
communicable disease, and emerging areas such as health economic analysis and urban health (e.g., homelessness). As
well, Public Health will retain the significant in-kind contributions that accrue from university partnerships (e.g., research
collaboration, information about funding opportunities, library access). These benefits accrue not just to Public Health but
to other City departments and divisions (e.g., Social Development, Parks and Recreation, Public Works).
The Division intends to reallocate the $844,046.00 in the 1999 PHRED budget into the 2000 cost-shared budget for
mandatory programs. Re-establishment of a PHRED program appropriate to the needs of Toronto will require $628,000.00
($314,000.00 net) in 2000, with an annualized impact of $1,256,000.00 gross ($628,000.00 net). This is less than the $2.3
million (gross) earmarked by the Ministry, reflecting the efficiencies that can be achieved by combining the three former
PHRED sites (East York, North York, Toronto) into one within the new City. Even so, the new Toronto site will be an
essential player in this provincial program, and it is imperative that the country's largest city and its largest universities
continue and strengthen this partnership.
Programs 100 Percent Funded by Ministry of Health:
The expansion of the Healthy Babies, Healthy Children program ($762,900.00 gross), the introduction of the Healthy
Babies, Healthy Children postpartum program ($2,744,300.00 gross) and the Preschool Speech and Language Program
($910,400.00 gross) represent no net increase to the Public Health base budget since they are 100 percent funded by the
Province. These programs (including PHRED) will add $4,731,600.00 in additional revenues to the operating budget.
(3) Priority Public Health Requests Required to Fulfill Mandatory Requirements:
Extensive business planning and redesign efforts are being undertaken within all Public Health programs in order to
achieve maximum efficiency and cost-effectiveness. Some programs and services are well along in their business redesign
processes while others will be phased in over the next three to five years.
Family Health and Healthy Lifestyles:
Within the Family Health and Healthy Lifestyle programs, immediate resource needs have been identified to enable
movement towards compliance with the Mandatory Guidelines. The additional resources for the 100 percent provincially
funded Healthy Babies, Healthy Children postpartum program have enabled the reallocation of 12 FTE positions into other
priority program areas. These will be assigned as follows: four FTE's for Cancer Prevention; 2.5 FTE's for Physical
Activity; 2.5 FTE's for Substance Abuse Prevention and three FTE's for Child Nutrition. The rationale for these internal
reallocations is outlined below.
Cancer Prevention:
Provincial Mandatory Guidelines direct Public Health units to reduce mortality from breast and cervical cancer by
increasing the number of women who receive screening and early detection services and to provide education and promote
policies that reduce the risk of skin cancers. Public Health's cancer prevention capacity is inconsistent across the City.
While work has begun in some areas of the City to reach communities at risk, currently there are insufficient staff resources
to provide consistent support and programs across the City. The four additional FTE's for Cancer Prevention will enable
Public Health to better support the Toronto Cancer Prevention Coalition, a group that provides innovative and
comprehensive cancer prevention services across Toronto's diverse population. The Coalition has served to focus Toronto
Public Health's cancer prevention efforts in a cost-effective manner, and has augmented the Division's capacity to carry out
a comprehensive mandate in preventing cancer.
Physical Activity:
Physical activity promotion has been under-resourced in Toronto Public Health, resulting in minimal programming and
poor compliance with Mandatory Programs. Children in Toronto are often being raised in a culture of inactivity. Current
research indicates that more than two thirds of adults are inactive and that children are four times less active than they were
40 years ago. A full 60 percent of children do not meet average fitness standards. Physical inactivity is a key risk factor in a
range of chronic diseases such as heart disease, cancer, osteoporosis and Type II diabetes. Participation in physical activity
is recognized as an effective strategy in preventing drug abuse and violence. It also enhances children's self esteem, social
competence and academic performance. Public Health has begun to address this crisis in children's physical activity
through inter-divisional collaboration on the Rainbow Fun Program, which serves to increase physical activity for
thousands of children in day care and recreation programs across the City of Toronto.
Public Health estimates that at least six FTE's would be required to expand the delivery of the Rainbow Fun Program to
licensed child care programs and other organizations serving children across the City, in order to increase child and family
physical activity across Toronto's diverse communities.
The 2.5 FTE's reallocated to Physical Activity from within the Family Health and Lifestyles program will enable the
Division to make considerable progress in promoting physical activity for families and children in Toronto.
Substance Abuse Prevention:
Among Toronto students, past year use of cannabis increased from nine percent in 1993 to 18 percent in 1995; the most
recent survey, completed in 1997, indicated past cannabis use among 19 percent of junior high and high school students in
Toronto. Increasingly youth are also using illicit drugs in clubs and mixing them with alcohol. Since August of this year,
two deaths and several hospitalizations have been associated with drug use in clubs and raves. This changing drug pattern
requires outreach in the youth community and development of unique strategies to reach youth who engage in these
activities.
The 2.5 FTE's reallocated to Substance Abuse Prevention will enable the Division to consolidate efforts to reduce illicit
drug use amongst youth and develop harm reduction strategies in collaboration with other agencies and community groups.
These resources will be targeted to enhance the substance abuse prevention capacity of those former suburban
municipalities of the City of Toronto which have been severely under-resourced in this area.
Child Nutrition:
A poor quality diet has proven long-term health implications for children. There has been substantial growth in the number
of Child Nutrition Programs across Toronto over the past year; from 207 in 1998, at a cost of $4.9 million, to over 300
programs in the 1999/2000 school year at a cost of $7.4 million. Child Nutrition Programs are coordinated through
partnerships with Public Health, schools and community organizations. Charitable foundations have contributed
considerable resources and cost savings have been achieved through bulk buying partnerships with school boards.
The Provincial Government contributes 24 percent of the total program costs while the municipal share has dropped from
24 percent to 17.8 percent, as a result of successful fundraising and bringing other partners into the program. The
remaining funds come from corporate and local fundraising, parent contributions and other grants. To date, municipal
funding for the Child Nutrition Program has leveraged close to 100 percent in additional contributions.
The creation of a Child Nutrition Program has strengthened the capacity of Public Health to fulfill its Mandatory Program
requirements by promoting access to healthy foods, supporting volunteers, developing guidelines that support healthy
eating and in providing food safety information. Over 34,000 children in Toronto currently benefit from the Child Nutrition
Program.
However, this rapid expansion of programs has placed additional demands on Public Health which cannot be met within
the existing staff complement. To ensure ongoing viability of a stable Child Nutrition Program across the new City of
Toronto, two more FTE's, in addition to the three FTE's reallocated from the Family Health and Lifestyles Program, are
required to be added to the base budget at a cost of $33,400.00 (net). This will strengthen the capacity of Public Health to
fulfill its mandatory requirements in Child Health and enable Public Health to consolidate the Child Nutrition Program,
leverage further support from the private sector and the provincial government, maximize contributions and ensure
nutritional quality of foods served.
Control of Infectious Diseases/Infection Control:
High risk and emerging diseases/outbreaks such as meningitis, "flesh-eating disease" or influenza in a long-term care
facility, require immediate Public Health response. This is a high-profile critical core function of Public Health. Toronto
Public Health responds to about 30,000 disease notifications and over 200 outbreaks each year. At this point, Toronto
Public Health does not have the capacity to respond to 25 percent of reported diseases (Hepatitis B and C and lower risk
enteric diseases) in a timely manner. In 1998, 54 percent of day nurseries did not receive the required two inspections. In
addition, new provincial requirements regarding infection control in Personal Service Settings (PSS) and follow-up of
Hepatitis C reports, must still be implemented by Public Health. Currently fewer than one percent of the estimated
5,000 PSS premises are inspected. Toronto Public Health is seriously concerned about its lack of capacity to respond to
major occurrences such as an influenza pandemic or an act of bio-terrorism. These would likely incapacitate the City and,
therefore, require dedicated resources and infrastructure to avert severe consequences.
(i) Minimal Mandatory Requirements:
The Control of Infectious Diseases/Infection Control Program, therefore, requires substantial additional resources to meet
the mandatory program requirements. It is estimated that, at minimum, an additional 23 FTE's would be required. This
would enable:
(a) the assessment of 100 percent of reported incidents and investigation of all reportable diseases and provision of a first
response within 24 hours;
(b) ensuring up-to-date policies and procedures to facilitate appropriate response to reportable diseases and outbreaks
including pandemic influenza;
(c) ensuring annual written communication with health care professionals, institutions and the community regarding the
control of infectious diseases;
(d) conducting required inspections of day nurseries and provision of annual in-service education sessions on basic
infection control for all staff providing direct care in day nurseries; and
(e) establishing a database of PSS premises and implementing the Ministry of Health Infection Control in Personal Service
Settings Protocol in all premises where there is a risk of exposure to blood.
This approach would cost an additional $513,300.00 (gross) for 2000 (plus $115,000.00 in one-time costs), with the
annualized impact for 2001 being $1,540,000.00 (gross). These funds would cover staff costs for 16 Public Health
Inspectors, two Managers, four clerical support staff and one health promotion specialist.
(ii) Optimal Requirements:
An additional 11 FTE's (for a total of 34 FTE's) would enable Public Health to be proactive in outreach and health
promotion/education to prevent occurrences of communicable diseases. This would include:
(a) providing targeted infectious disease information to health care professionals, institutions and the community, including
information on travel health, antibiotic use and antibiotic resistant organisms;
(b) proactive public education/outreach on the prevention and control of communicable diseases;
(c) working proactively with all hospitals, nursing homes, homes for the aged and day nurseries on the development and
revision of infection control policies, and to assist in developing and delivering infection control in-service education
sessions for staff;
(d) encouraging disease surveillance in day nurseries to establish baseline data; and
(e) developing detailed protocols for responses to acts of bio-terrorism.
This approach would cost an additional $727,700.00 (gross) for 2000 (plus $170,000.00 in one-time costs), with the
annualized impact for 2001 being $2,183,000.0 (gross). These funds would cover staff costs for 22 Public Health
Inspectors, two Managers, five clerical support staff, one Health Promotion Specialist, one Epidemiologist, one media
person and one IT specialist. The optimal approach is outlined here to illustrate the magnitude of the requirements facing
Toronto, but is not recommended for consideration this year in order to contain costs.
Information Technology (IT) Support:
Public Health has one of the largest number of databases and applications in the Corporation (115) second only to Finance.
Nonetheless, Public Health remains poorly resourced in the area of IT support. The Corporate IT service providers confirm
the need for additional resources dedicated to Public Health, but have no additional resources to allocate at this time and
are currently in the process of determining services to be provided to client departments in 2000.
Currently, the following critical Public Health data systems are maintained by contracted Y2K technical specialists who
have assisted in the integration and implementation of these systems across the Public Health Division: RDIS (Reportable
Disease Information System); IRIS (Immunization Records Information System); DOT System (records of clients
participating in the Directly Observed Therapy Program for the treatment of tuberculosis); DIS (Dental Information
System); CINOT (the Children in Need of Treatment reporting system to collect payment from the Province for dental
services provided); and CISS (the Computerized Inspection Services System). The contracts for these specialists will end
in 1999.
Dedicated support for Public Health IT users is largely unavailable given the extremely limited number of staff (five FTE's)
to provide all user support across the 32 locations of the new Division. Public Health has been working in collaboration
with Corporate IT to ensure consistency with corporate standards and leasing agreements. Public Health has received
verbal endorsement for our capital and operating IT request from the Executive Director, Corporate Information and
Technology Division, and written confirmation is forthcoming.
Public Health is, therefore, requesting an additional nine FTE's to enable the Division to more effectively operate the data
systems identified above and to provide a minimally consistent level of user support across the Divisions. The operating
budget request includes funding for the monthly fees for IT connectivity to Bell Canada lines and between Public Health
sites, at a net cost of $70,000.00 for 2000 (implementation of upgrade process, June 1). An additional one time expense of
$37,250.00 is requested for renewal of licenses to access programs ($17,250.00) and workstations for the nine new staff
($20,000.00).
Capital Budget Request - IT Hardware:
Toronto Public Health remains severely under-resourced in IT hardware, specifically computers, shared printers, fax
machines and the technology required to connect Public Health IT systems to central systems and servers.
Public Health has submitted a Capital request for the year 2000 in the amount of $936,000.00 to begin to address the
shortages in IT equipment required to support the delivery of services.
A thorough assessment of the Division's current IT inventory and needs has been completed. The Division's goal is to
ensure that wherever the shared use of computers and related equipment is possible these shared arrangements will be
implemented. The Division will work toward achieving an average ratio of five people to one computer. The 2000 Capital
request ($421,107.00) for new computers (shared and dedicated) will help us move closer to these ratios, where currently
we have as many as 14 users to one computer in some areas. The request also includes printers for offices currently without
a printer ($270,894.00) and upgrades to computers as well as upgrades and/or installation of IT connection at 32 Public
Health sites ($244,000.00).
Emergency Planning and Response:
The Medical Officer of Health (MOH) has a separate and distinct legal responsibility for emergency preparedness. In
particular, the MOH is a member of the Toronto Emergency Planning Committee and is present at the Emergency
Operations Centre in the event of a declared emergency. Toronto Public Health is concerned about its current capacity to
fulfill this vital role regarding emergency planning which is also a mandatory provincial requirement. The Division,
therefore, requires a dedicated full-time staff person whose primary purpose would be emergency planning and cementing
linkages with other key stakeholders involved in emergency response efforts in the City. The cost for this in 2000 would be
$19,000.00 (net, six months).
Raccoon Rabies:
Raccoon rabies has been detected in locations as close to Toronto as the Ottawa Valley. Despite provincial efforts to
prevent racoons from entering Canada from the United States, it is highly likely that many have already crossed the border
and are at risk of migrating to Toronto.
Raccoons interact with pets, especially cats, which exist in high numbers in the City, frequently roam at large and often
share dens with raccoons. Given the very high number of raccoons and pets per capita in Toronto, raccoon rabies could
spread rapidly in the City if it becomes established. Public Health is seeking Board of Health approval for a one-time cost
of $100,000.00 for traps, protective clothing and other equipment required for the "trap, vaccinate and release" program,
and an additional $150,000.00 annually to purchase vaccine and other consumable items.
Conclusion:
This report identifies the pressures on the 2000 Public Health Operating Budget along with the costs of Council directed
initiatives and high priority expansions to fulfill mandatory program requirements. The Board of Health is requested to
endorse the operating and capital budget submissions and forward these to the City of Toronto's Budget Advisory
Committee for consideration during the 2000 budget process.
Contact Name:
Dr. Sheela Basrur, Medical Officer of Health, Tel: 392-7402, Fax: 392-0713.
(A copy of Appendix "A" attached to the foregoing report was forwarded to all Members of Council with the Agenda for
the Budget Advisory Committee of December 9, 1999, and a copy thereof is on file in the office of the City Clerk.)
_________
(Report dated October 15, 1999, addressed to the
Board of Health from the Medical Officer of Health,
entitled "PHRED Budget Interim Re-establishment")
Purpose:
This report updates the Board of Health about the Public Health Research Education and Development (PHRED) program,
and seeks policy approval to re-establish this program.
Financial Implications:
There are no impacts on Public Health's 1999 gross or net budgets. The 2000 Operating Budget request will include a
funding request for a PHRED program at a cost of $628,000.00 gross ($314,000.00 net), subject to Council approval.
Should City Council not approve a 2000 PHRED budget, Public Health will have to absorb the January to April interim
cost of $129,132.00 internally, thereby creating additional budget management pressures.
Recommendations:
It is recommended that:
(1) the Board of Health endorse the re-establishment of the Toronto PHRED program with a funding arrangement for 50
percent of the program budget to be funded by the Ministry of Health;
(2) the Board of Health request that the Policy and Finance Committee authorize Public Health to spend $35,000.00 in
1999, using funds already existing in Public Health's Operating Budget, and $129,132.00 gross ($64,566.00 net) between
January and April 2000, to contract short-term staff and implement a partial PHRED program, pending final Council
approval of the 2000 Operating Budget; and
(3) the Board of Health, in collaboration with the Association of Municipalities of Ontario (AMO), seek 100 percent
provincial funding for the PHRED program.
Background:
The PHRED program, previously known as the Teaching Health Unit program, is a provincial program to improve public
health practice through applied research (e.g., benchmarking, effective practice assessments), education of students of
public health and existing public health practitioners, and access to research literature for on-going program improvement.
Toronto is one of six PHRED sites in Ontario, each of which is affiliated with one or more academic health sciences
centres.
Historically PHRED was 100 percent funded by the Ministry of Health. During 1998 and 1999, Toronto Public Health
reduced its PHRED program from $2.6 million (including $0.3 million in special project revenue) to $0.8 million in
anticipation of provincial funding being eliminated. On March 23, 1999, the Province announced a return to 50/50
cost-sharing of provincially mandated public health programs. Confirmation of the status of the PHRED program and
details of the provincial allocation to Toronto for PHRED were not available prior to Council's adoption of the 1999
Operating Budget. On March 26, 1999, the Budget Committee was informed that current municipal funding would be
lower than the amount available from the Province, and that achieving the full provincial subsidy would require an increase
in this program budget. Since Toronto received verbal information that the Province will allocate up to $2.3 million (50/50
cost-shared) annually to the Toronto PHRED program, I have worked with the Chief Financial Officer and Treasurer and
the Commissioner of Community and Neighbourhood Services regarding the best mechanisms to adjust the Public Health
budget to reflect this program re-establishment. Concurrently, Toronto has continued to argue that this program should be
100 percent provincially funded.
Toronto has had a PHRED program since 1985. During that time, the PHRED program built a strong base of expert staff to
enhance public health practice. The program's practical applied research projects, evaluation of programs and services,
provision of educational events for staff and participation in collaborative provincial benchmarking and effectiveness
projects have enhanced the quality of Toronto's public health service. PHRED research findings have resulted in positive
changes to provincial programs (e.g., Healthy Babies lay visitors) and local programs (e.g., food safety protocols). The
PHRED program has drawn external grants and additional provincial revenue to Toronto (e.g., new funding for
post-partum home visiting). As well, PHRED generates in-kind contributions that accrue from university partnerships (e.g.,
research collaboration, information about funding opportunities, library access). This benefits not just Public Health, but
also other city departments and divisions (e.g., Social Development, Parks and Recreation, Public Works).
Comments:
Unlike other cost-shared funding, the PHRED budget is implemented in the manner of matching funds whereby the
provincial contribution supports provincial activities and the municipal contribution supports local activities. The Chief
Medical Officer of Health of Ontario has established specific activities that can be funded by the municipal 50 percent and
by the provincial 50 percent, and is approving each participating health unit's PHRED workplan prior to flowing provincial
funding.
The Ministry recently struck a PHRED Advisory Committee to modify purposes, governance and set performance
measures. Toronto's representatives are Ms. Shirley Hoy, Commissioner of Community and Neighbourhood Services
(Association of Municipalities of Ontario designate), and Ms. Connie Clement, Director of Public Health Planning and
Policy (PHRED unit designate). The PHRED Advisory Committee appointees are unanimous in recommending that the
Province re-establish 100 percent provincial PHRED funding.
In establishing the 1999 budget, Public Health informed the Budget Committee (March 26, 1999) that the remaining
$844,046.00 budget initially designated for the PHRED program is required entirely for local program fulfillment of other
mandatory program requirements (e.g., program planning and evaluation, community health status information). The fact
that these funds were designated as PHRED reflects East York, North York and the former Toronto's previous
maximization of 100 percent provincial funding to pay for what have become basic health unit functions (e.g.,
epidemiology and data analysis). During 1999, staff were reassigned away from provincial PHRED commitments to assist
the Division with strategic business planning and operational planning; redesign of programs to ensure harmonized
serviced delivery and new mandated requirements in the context of local need; and staff training and development to
provide adjusted services. Our primary 1999 involvement in the PHRED partnership has been in program coordination and
planning with the intention that the Toronto PHRED program would be re-established. Our partnership agreements with
the University of Toronto and Ryerson Polytechnic University have not been renegotiated since amalgamation.
There are two key losses for Toronto should Toronto Public Health withdraw from the provincial PHRED partnership:
(a) Loss of revenue and program enhancement: Without re-establishment of a PHRED program similar to our previous
programs in North York, East York and the former Toronto, Public Health will be unable to hire staff to support evaluation
and applied research (especially in environmental health, dental health and communicable disease) and to support applied
research in emerging need areas such as health economic analysis and specifically urban issues (e.g., health aspects related
to homelessness, inner city interventions).
(b) Weakening of partnerships with the University of Toronto, Ryerson Polytechnic University and other health units: As
the largest health unit in Canada's largest city with some of Canada's most esteemed health and medical schools, the
positive working relationships we have established in these institutions have been very constructive. Should we withdraw
from PHRED, Toronto would lose in-kind contributions to research projects, information about funding opportunities and
ready access to university holdings. As well, costs to access the University of Toronto library would increase.
Leaving the provincial-university-local partnership in abeyance until the 2000 Operating Budget approvals was considered;
however, it was recently learned that two additional municipalities have applied to be PHRED sites and access the
Province's limited PHRED budget. While our future funding is not yet in jeopardy, it is prudent for Toronto to show good
faith by re-establishing the PHRED program on an interim basis while seeking 2000 Operating Budget approval. As well,
the Ontario Chief Medical Officer of Health has verbally told PHRED representatives that the Province will not flow funds
to the other PHRED sites until all aspects of the provincial PHRED budget are finalized. In effect, Toronto, the only
PHRED site that has not yet established a 1999 PHRED budget, must finalize its budget in order for the Ministry to release
any PHRED funds.
Interim Re-establishment for 1999 and 2000:
To maintain Toronto's future capability to have a PHRED program, the Board of Health should recommend to the Policy
and Finance Committee approval of interim re-establishment of the PHRED program. Specifically, Public Health requests
approval to hire four temporary, contract PHRED-designated staff positions for the balance of 1999, using up to
$35,000.00 funds already existing in Public Health's Operating Budget. Further, Public Health seeks authority to maintain
these four contract positions until 2000 budget approval by City Council at an estimated cost of $129,132.00 gross
($64,566.00 net). Should Council not approve a 2000 PHRED budget, these contracts will be terminated and the January to
April costs will need to be absorbed internally by Public Health, creating additional budget pressures.
The interim re-establishment approval is being sought for four positions which would have the most immediate benefit for
the City: a dental health specialist, a communicable disease specialist and two additional program evaluators/applied
researchers. These positions would support local programs through applied research and evaluation. The contract staff
would also contribute to provincial objectives that benefit Toronto, such as collaborative effectiveness reviews,
benchmarking and public health training.
The 2000 Operating Budget request will clarify the Division's 1999 intention to reallocate the $844,046.00 designated as
PHRED in the 1999 budget into the routine cost-shared budget related to mandatory programs. Further, the request will
include a recommendation to re-establish the PHRED program at a 2000 gross budget of $628,000.00 (net, $314,000.00),
with an annualized impact of $1,256,000.00 gross ($628,000.00 net). This is less than the $2.3 million (gross) allocated by
the Ministry, reflecting the efficiencies that can be achieved by combining the three former PHRED sites (East York, North
York, Toronto) into one within the new City. The request for authority to proceed now with only a small, interim program
ensures that policy discussion about the future of Toronto's PHRED program will occur within the context of the 2000
budget.
Conclusions:
The PHRED program benefits both Toronto and Ontario. To retain Toronto's ability to re-establish a permanent PHRED
program able to positively impact on local and Province Public Health practice and service delivery, it is recommended
that the Board of Health request the Policy and Finance Committee to authorize Public Health to proceed to implement a
small-scale, interim PHRED program. It is important to realize that municipalities without PHRED funding have applied to
the Ministry of Health for PHRED status and access to the limited provincial PHRED budget. The Province is presently
withholding funds from the five municipalities that have established 1999 PHRED budgets until Toronto, the one
outstanding site, settles a budget. It is imperative that Canada's largest city and its prestigious universities continue to
benefit from the PHRED partnership.
Contact Name:
Ms. Connie Clement, Director, Public Health Planning and Policy, Tel: 392-7463, Fax: 392-0713, Email:
cclement@toronto.ca.
_________
(Report dated October 6, 1999, addressed to the
Board of Health, from the Medical Officer of Health,
entitled "Resources Required for Transfer of the Youth
Mentoring Program to Toronto Public Health")
Purpose:
To identify resource requirements to implement the transfer of the Youth Mentoring Program from the Healthy City Office
to Toronto Public Health and to expand the program City-wide, as recommended in the July 22, 1999 Board of Health
report, "Impact on Public Health of Implementing the Report of the Task Force on Community Safety".
Financial Implications:
Public Health Operating Budget to include $43,745.00 for the year 2000 and annualized to $82,490.00 by the year 2001 to
fund one FTE for the Youth Mentoring Program and some minimal program costs.
Recommendations:
It is recommended that:
(1) the Board of Health support the addition of $43,745.00 for 2000 and $82,490.00 for 2001, to cover one FTE staff
position for the One on One Mentoring Program and that these monies be added to the base operating budget of Public
Health; and
(2) this report be forwarded to the Children and Youth Action Committee for their information and endorsement.
Background:
At its July 22, 1999, meeting, the Board of Health requested the Medical Officer of Health to report back on the resource
requirements to implement the transfer and expansion of the Youth Mentoring Program to Public Health.
The Youth Mentoring Program, now referred to as the "One on One Mentoring Program", provides high-risk children aged
5 to 12, with extra guidance and support that can prevent drug use, gang membership, negative school behaviour, violence
and crime. Students participating in the program are identified by teachers and school staff as having special needs for
caring and one-on-one relationships with adults. Mentors for the program are chosen from both staff volunteers of the
former City of Toronto and members of the Downtown Rotary Club.
The One on One Mentoring Program was coordinated through the Healthy City Office from January 1996 through August
1999. Due to changes in the structure of Healthy City, Public Health agreed to coordinate the program from September 1,
1999, and to begin the program expansion City-wide during the 1999-2000 academic year if resources would be provided.
Comments:
The One on One Mentoring Program started as a pilot project in two inner city Toronto schools during the 1996-1997
academic year. During the pilot, fourteen employees of the City of Toronto Department of Parks and Recreation and Public
Health, were carefully screened and selected as mentors. The staff volunteer one hour per week to meet with the child in
school and the employer provides travel time. The evaluation of the pilot project reaffirmed the effectiveness of mentoring
in promoting positive self-esteem, increasing social and problem-solving skills and discouraging school dropout.
In the three years of existence, One on One Mentoring Program has more than tripled in size. At present, there are 40
mentors, who are employees of the former City of Toronto and members of Downtown Rotary Club paired with 40
students in five Toronto inner city schools. To continue the implementation of the program this academic year, Public
Health has reassigned resources. It, however, can not absorb the resources necessary to expand the program City-wide.
The expansion and maintenance of the program requires a full time staff person and additional resources in order to:
(1) recruit volunteers from the potential 50,000 employees of the City and from members of other Rotary Clubs across the
City;
(2) interview and screen volunteers;
(3) develop orientation and training programs for new mentors;
(4) develop on-going professional development activities for mentors;
(5) maintain the level of support in the present five schools and seek commitment from at least one school in each of the
Community Council areas;
(6) negotiate expansion with Rotary clubs and explore expansion with other corporations;
(7) work with Public Health Nurses in schools to provide support to mentors;
(8) establish on-going communication mechanisms with mentors and school contacts;
(9) organize planned activities with children, with families and with mentors; and
(10) work with the community advisory committee in program development and evaluation.
As the One on One Mentoring Program is being expanded, Public Health will establish strong linkages with two other
programs focusing on children and youth-at-risk. These are the Ambassador Program and the Young Parents With No
Fixed Address Committee. This will enable staff to share experience and expertise across the programs.
Conclusion:
One additional full time equivalent (FTE) with program resources is required to implement the expansion and continued
support of the One on One Mentoring Program.
Contact Name:
Ms. Liz Janzen, Regional Director, Toronto Public Health, Tel: 392-7458, Fax: 392-0713, ljanzen@toronto.ca.
_________
(Report dated October 15, 1999, addressed to the
Board of Health from the Medical Officer of Health,
entitled "Hot Weather Response Plan Update")
Purpose:
This report is a follow-up to the Hot Weather Response Plan, discussed at the July 22, 1999 meeting of the Board of
Health. It puts forward the budget required for a corporate Hot Weather Response Plan for the year 2000 and presents the
preliminary year 2000 protocol.
Financial Implications:
Endorsement of this project will result in a net increase of $150,000.00 to the year 2000 Operating Budget.
Recommendations:
It is recommended that:
(1) the Board of Health endorse the addition of $150,000.00 in the year 2000 Operating Budget for Public Health to cover
the cost of the corporate Hot Weather Response Plan. The approval of this project is subject to further consideration by the
Budget Sub-Committee as part of the 2000 Operating Budget process; and
(2) the Medical Officer of Health report to the Board of Health, and Council, the results of the summer alerts in the fall of
2000.
Background:
At its meeting on July 22, 1999, the Board of Health had before it a report from the Medical Officer of Health, outlining an
interim Hot Weather Response Plan, recommendations for assessment of current City resources and services, and longer
term recommendations for research and policy development. The Board endorsed the 17 recommendations (Appendix "A")
before it and on July 27, 1999, City Council approved them.
In 1999, a Heat Warning was called on Friday, July 31, 1999, for the following day, in accordance with the forecast from
Environment Canada of a Humidex warning of over 40 degrees Celsius. Heavy rain developed early Saturday morning and
the Humidex in fact dropped to below 40. This experience highlighted the difficulties in mobilizing the Hot Weather
Response protocol on weekends and in predicting the Humidex level which can change rapidly.
Public Health spent about $27,000.00 in developing and implementing the Hot Weather Response protocol and education
materials in 1999. The expenditures included: TTC tokens; a contract with Environment Canada; Red Cross first aid
training for volunteers and staff of community centres dealing with vulnerable populations; extended hours for
Anishnawbe Health Toronto Street Patrol; a contract with Community Information Toronto; printed education materials;
and development of an up-coming one-day workshop on the public health impact of extreme heat, on Friday, December 3,
1999.
Comments:
Environment Canada has provided humidex data for the years 1953 to 1999. The data was collected at Pearson monitoring
station and covers the months of April through September. On average, the Humidex has reached or exceeded a level of 40
degrees Celsius on 4.13 days per year (range 0 to 14) and has hit 46 degrees Celsius or above twice, in September 1953.
Using the current protocol, we can, therefore, expect a Heat Warning to be called up to four times per year.
(1) Protocol Development for 2000:
Public Health chairs a Heat Committee that includes: Public Health, Libraries, Toronto Housing Company, Parks and
Recreation, Shelter Housing and Support, Red Cross, Community Information Toronto, Ambulance Services, Regent Park
Community Health Centre, Toronto Community Care Access Centre, Out of the Cold, Anishnawbe Health Toronto, and
Toronto West Seniors Network.
The Committee reviewed the protocol for 1999 and is in the process of making revisions for 2000. Some revisions are well
underway, others are under development.
Proposed Role of Different Heat Committee Members:
(a) Public Health will monitor Humidex level, call the Heat Warning, and continue to provide TTC tokens, contract with
Environment Canada, contract with Community Information Toronto, cover the cost of extended hours for Anishnawbe
Health Toronto's Street Patrol, and print and distribute education materials. Public Health will develop a protocol to contact
high-risk clients on weekends;
(b) Libraries - 52 library branches will be designated to have extended open hours on weekday evenings during a Heat
Warning. These branches are in areas of the city in which high priority children and seniors live. For 2001, the plan could
be extended to Saturday evenings, pending an evaluation of the 2000 plan, particularly public response, use, service issues
and availability of staff volunteers. The extension of the plan to Sundays after 2001 should be co-ordinated with the
extension of year round Sunday library service. The estimated average cost per day of implementing extended hours on
weekdays is $6,929.00. (Costs vary per day of the week, ranging from no cost on Thursdays when all branches are open, to
$15,761.00 on Mondays when many branches are closed.);
(c) Shelter, Housing and Support will continue to work with the drop-in sector to identify issues regarding access during
evenings and weekends;
(d) Toronto Housing Company (THC) will continue to update the inventory of its buildings including air-conditioned
spaces, ventilation and air-handling units as part of its long-term capital expenditures planning. At present, there is an
air-conditioned recreation area in almost every senior's building with predominately senior tenants, which tenants can use
for relief in extreme hot weather. THC will continue to circulate education materials and build on existing mutual support
initiatives with tenants and community agencies to ensure tenants are well informed about precautions to take for hot
weather;
(e) Parks and Recreation will continue to keep swimming pools open past regular hours at some locations during a Heat
Warning. They are also in the process of determining other appropriate divisional responses;
(f) Toronto Community Care Access Centre will develop a plan to identify and contact vulnerable clients on Heat Warning
days; and
(g) Red Cross will deliver bottled water to public facilities such as libraries and community centres where vulnerable
people likely gather; conduct street and park outreach to homeless people and provide them with transportation to a cool
place if needed; and respond to requests to check on seniors if needed. Since most of these activities are during day time
hours, a limited number of volunteers will be available. Red Cross will, therefore, need to use staff for most of these
activities, at a cost of $600.00 per day. Red Cross will also provide training to front-line staff and volunteers of community
agencies on first aid related to heat stroke and heat exhaustion across the City. The estimated cost of this is $12,000.00.
(2) Partnership:
Public Health has initiated linkages with the Ontario Community Support Association, an organization of home support
agencies serving frail and isolated seniors. Public Health is also working with a network of agencies with staff providing
crisis intervention and assessment services to clients at risk for heat related illness. Both networks will be added to the fan
out when a Heat Warning is called.
Public Health is working in collaboration with community health centres across the City such as Queen West, Parkdale,
Regent Park and the Anne Johnston Health Station, to enable a more comprehensive approach during extreme hot weather
and to reduce negative health impacts for their clients.
Project Warmth received private donations of bottled water to make available to agencies serving homeless people. This is
expected again for the year 2000. A small working group of the Advisory Committee on Homeless and Socially Isolated
Persons oversees the bottled water distribution mechanism throughout the summer. They will be making recommendations
for improved co-ordination and enhancement subject to their review of the past summers experience.
On "Heat Warning" days, Red Cross and Out of the Cold will co-ordinate water distribution.
(3) Learnings from Other Jurisdictions:
A workshop has been planned for December 3, 1999 to learn how other jurisdictions have determined heat warning
thresholds as well as how they have developed and evaluated appropriate protocols for their heat warning programs. This
workshop will be an opportunity to explore research partnerships in areas such as health policy development and
surveillance systems for health consequences of hot weather.
Public Health has also established linkages with the University of Alberta research group in Edmonton to develop a
Toronto specific threshold for the heat warning protocol. This work should be completed in the spring of 2000.
Public Health has begun preliminary planning with the Toronto Atmospheric Fund for a North American conference in
2000 in Toronto. The conference will address the impact of global warming on urban centres and examine methods to
mitigate summer heat over the long term. In addition, the Division is collaborating with the Toronto Atmospheric Fund to
finalize a proposal for the Environment Canada Climate Change Action Fund to support the 2000 conference and other
research projects. The City's contribution to this conference would be up to $50,000.00.
Public Health is identifying hospitals in Toronto which collect data that would be useful in developing an active
surveillance system to track the health impacts of heat stress. Data would include emergency room visits and increased
mortality rates.
(4) City-wide Emergency Plan:
A response to extreme hot weather conditions where a heat emergency would be called (Humidex over 45 degrees Celsius)
still needs to be incorporated into the City's Emergency Plan. The findings of the December 3, 1999, workshop will be
extremely helpful in this process.
(5) Cost Estimate:
In 1999, although approval was granted for up to $150,000.00, expenses amounted to $27,000.00. These expenses were
related to education outreach, one day of an alert, and workshop development. This cost was absorbed within the 1999
Public Health approved budget as a result of underspending in the Cold Weather Alert account. For 2000, the estimated
costs based on four Heat Warning days are as follows:
Education Materials and Translation $20,000.00/annum
TTC Tokens $15,000.00/annum
Contract with Environment Canada $ 500.00/annum
Red Cross Training $12,000.00/annum
Anishnawbe Health $ 400.00/day
Library Extended Hours $ 6,929.00/day
Community Information Toronto $ 3,000.00/annum
Other $20,000.00/annum
Conference $50,000.00 one time
Therefore the total cost estimate for 2000 is $150,000.00.
Conclusions:
The implementation of the Hot Weather Response Plan for 1999 provided insufficient information to enable individual
divisions to develop detailed Operating Budgets for 2000. Based on the initial protocol development for 2000 and an
expectation that the Heat Warning would be called up to four times per year, it is recommended that $150,000.00 be
allocated to Public Health's budget for the year 2000 to cover the expenses of the corporate Hot Weather Response Plan
and the North American conference. Public Health will co-ordinate the response and will report back by spring 2000 on a
more complete protocol including recommendations regarding heat warning thresholds for medium and emergency
responses.
Contact Name:
Ms. Liz Janzen, Regional Director, Toronto Public Health, Tel: 392-7458, Fax: 392-0713, ljanzen@toronto.ca.
________
Appendix "A"
Recommendations from the Board of Health Report July 22, 1999
Hot Weather Response Plan
(1) That the Board of Health recommend that City Council adopt the interim Hot Weather Response Plan as outlined in
Appendix "A".
(2) That up to $150,000.00 be set aside within the Department of Community and Neighbourhood Services through
internal reallocations from Toronto Public Health and the Shelter, Housing and Support Division to cover the expenses in
1999 of the Hot Weather Response Plan.
(3) That the Medical Officer of Health (MOH) continue to consult with other city agencies, volunteer organizations and
community groups to determine how they can best contribute to the Plan.
(4) That the Toronto Public Health contract with Environment Canada to provide ongoing forecast and timely notifications
of Humidex levels for Toronto.
(5) That the MOH co-ordinate the development of a comprehensive, city-wide response and its potential costs for
consideration during the 2000 budget process. This comprehensive plan may include specific actions by other City
agencies, volunteer groups and community organizations co-ordinated by Toronto Public Health and an evaluation
component to ensure that the goals of the Plan are being met.
(6) That the MOH expand the yearly public health education campaign directed towards hot weather to increase the
public's knowledge of the appropriate responses. This should include an emphasis, where possible, on community
development strategies including the creation of neighbourhood partner programs for vulnerable residents, along with the
provision of information to organizations that serve members of vulnerable populations.
(7) That the Commissioner of Economic Development, Culture and Tourism be requested to improve access to permanent
sources of potable water (e.g., drinking fountains) along with bathing and washroom facilities in drop-in centres and
community centres, in consultation with local businesses and community organizations that serve Toronto's homeless and
underhoused populations.
(8) That the Commissioner of Community and Neighbourhood Services and the Commissioner of Economic Development,
Culture and Tourism assess the present state of community centres, drop-in centres and other publicly owned/operated
gathering places that could be used as places for people to cool off and as places to bathe. The response should identify
resources needed to up-grade and expand these facilities, including installing air conditioning and bathing/washroom
facilities where necessary and extending their hours of operation.
(9) That the Toronto Housing Company, as part of its Tenant Support Program, develop responses for when a heat warning
is issued by the summer of 2000.
(10) That the Commissioner of Community and Neighbourhood Services conduct research to better quantify the extent to
which Toronto residents are at increased risk for heat related illness as a result of poor ventilation, inadequate air
conditioning or other conditions in their homes.
(11) That the MOH further investigate the health effects of hot weather and consult with Environment Canada and other
agencies to gain a better understanding of the weather systems that have a substantial impact on health.
(12) That the MOH consult with area hospitals, physicians, Toronto Ambulance Services and other interested parties on the
feasibility of establishing an active surveillance system focusing on the health impacts of heat stress caused by hot weather,
such as emergency room visits and increased mortality.
(13) That the Toronto Public Health participate in research into the relationship between hot weather and local health
effects using data from the surveillance system and other sources and use the results to establish a scientific basis for heat
response thresholds.
(14) That the Toronto Atmospheric Fund be requested to collaborate with the Toronto Public Health to develop a workshop
in the fall of 1999 on hot weather responses involving experts from Canada and from American cities that have
successfully implemented heat emergency plans.
(15) That the Toronto Atmospheric Fund be requested to analyze the Toronto heat island effect and identify methods to
mitigate summer heat over the long term, such as enhancing the urban forest, promoting green rooftops and gardens, and
encouraging the use of lighter coloured construction material for rooftops that minimize energy use, thereby reducing the
impact on air pollution and climate change.
(16) That the Toronto Public Health consult with the Toronto Atmospheric Fund on the development of policy options and
proposed programs to mitigate the summer heat over the long term from a global warming perspective.
(17) That City Council authorize and direct the Chief Administrative Officer to incorporate into the City's Emergency Plan
a response to extremely hot weather conditions (Humidex over 45 degrees Celsius), should they arise.
