toronto.ca/health Annual Report 2013 toward a healthier city

Transcription

1 Annual Report 2013 toward a healthier city

2 2013 report Our Mission Toronto Public Health reduces health inequalities and improves the health of the whole population. Our Principles We are accountable for delivering excellence in all our programs and services while striving to meet the needs of Toronto s diverse communities within a commitment to health equity. Accountability Toronto Public Health (TPH) is accountable to the Board of Health, Toronto City Council, the Government of Ontario, and to the people of Toronto for delivering services that meet community health needs, comply with Ontario Public Health Standards, and make wise use of human and financial resources. Community Engagement TPH collaborates with community-based organizations, residents and partners in a diverse range of sectors to build community capacity, promote resilience and provide responsive services. Excellence TPH demonstrates a commitment to excellence by using evidence to support the design and delivery of programs, by ensuring continuous improvement in organizational performance, and by providing ongoing learning opportunities to realize the full potential of staff. Diversity TPH embraces diversity in all its dimensions, recognizing the changing face of our global and local population as a health asset, and promoting respect for all in everything we do. Health Equity TPH strives to reduce health inequalities that exist as a result of the unfair distribution of income, goods and services, and opportunity. TPH pursues health equity by working with others to identify and respond to the health needs of priority populations, and by advocating for policies that address the social determinants of health. Our Mission 1 Toward a Healthy City for All 2 Message from the Board of Health 4 Message from the Medical Officer of Health 4 Vulnerable Populations 5 Many health interventions that target the whole population do not reach the most vulnerable in our society. TPH develops services to meet the needs of those at highest risk of poor health outcomes. Healthy Living 9 Many diseases and injuries can be prevented by healthy decisions. TPH promotes healthy options in the areas of nutrition, tobacco, injury prevention, physical activity and sexual health. Early Childhood and Family 12 Children deserve the best possible start in life. TPH s prevention and early intervention services support healthy outcomes for children and new families. Health Protection 15 TPH safeguards the health and well-being of the public through a broad array of programs and services. These include preventing the spread of communicable diseases and responding to threats to population health. Healthy Environments 18 Healthy people need healthy environments. By working together with our community and partners we are helping create a healthy environment for all. Funding Public Health 21 Toronto Health Indicators 22 Public Health Communications 24 1

3 TOWARD a HEALTHY CITY for ALL 1. Through our Infant Hearing Screeners, babies with a hearing loss are found very early and given the help they need to develop language. 2. Children develop food skills and learn about healthy eating at workshops led in partnership with community youth leaders. 3. Toronto Public Health and partners launch the Mobile Good Food Market bus. The market increases access to fresh, diverse and affordable produce in the city. 4. Staff engage with the community at a display. Residents can Spin the Wheel to learn about tobacco cessation and the dangers of tobacco use. 5. There are approximately 17,000 food service premises in the city that are inspected by Toronto Public Health. 6. Dieticians train community leaders on healthy food preparation techniques as part of our diabetes prevention program

4 Great cities are ones that are prosperous, liveable and healthy. Toronto Public Health works to improve the health of the entire population and to overcome health inequalities through our many free services, programs and advocacy work Everdale At an Early Parenting Program, Public Health Nurses help new parents develop relationships with their babies. Building a strong foundation in early childhood leads to better childhood outcomes. 8. Public Health Inspectors monitor the water quality of 1,680 swimming pools, spas (hot tubs) and wading pools in Toronto. 9. Toronto Public Health keeps all children healthy by making sure students in schools are immunized. 10. To promote growing food in urban spaces, TPH and partners developed a guide for assessing soil safety in urban gardens. 11. Staff are available to do workshops and displays in the community on child passenger safety. Parents learn how to install a car seat correctly, what type of car seat is right for their child and other tips. 12. Public Health Nurses provide free breastfeeding support and consultation to help families achieve their optimal infant feeding goals. 13. Free dental care is available for eligible seniors, children and youth. Toronto Public Health has 23 dental clinics across the city.

5 report 2013 Councillor Joe Mihevc Chair, Toronto Board of Health As Chair of the Board of Health for the City of Toronto, I am pleased to present the Annual Report of Toronto Public Health for Toronto Public Health, as this report shows, plays a vital role in protecting and promoting the health of all in Toronto and in doing so strives to address the health inequities that we face as a city. I wish to acknowledge the contributions of my fellow board members, both civic appointees and elected officials, the Medical Officer of Health, and the staff of Toronto Public Health. In ways both large and small, hidden and visible, your efforts contribute to the health and well-being of us all. Dr. David McKeown Medical Officer of Health On behalf of Toronto Public Health, I am pleased to present our Annual Report for The work of Toronto Public Health is shaped by two requirements the Ontario Public Health Standards set out under the Health Protection and Promotion Act, and our commitment to understanding and responding to the diverse health needs of the city, communities and families we serve. The work of public health that is often in the news foodborne illness, infectious disease outbreaks and emergencies, is a small sample of the many ways public health services, research, education and advocacy make Toronto a healthier city. I invite the reader to gain a better understanding of the vital role of public health in protecting and promoting the health of all the residents of Toronto. 4

6 2013 charles hastings lecture vulnerable populations How Racism is Harmful to Your Health: 2013 Hastings Lecture "Racism is bad for your health; it is a public health issue in Toronto" began Dr. David McKeown in setting the stage for the 2013 Charles Hastings Lecture on Public Health that took place on October 29th at the sold-out Isabel Bader Theatre. The event helped to significantly raise attention around the issue of racism and health. The Hastings Lecture is an public lecture on the social determinants of health. Last year's keynote address, entitled "Race and Health A Healthy Future for All" was delivered by Dr. David Williams, Harvard University professor and internationally recognized authority on racism as a determinant of health. "Everyday discrimination is positively associated with many poor health outcomes. Racism has a weathering effect. The ongoing adversity of everyday discrimination, and the heightened vigilance that comes with it, wears the body down," explained Dr. Williams to the audience. Drawing primarily on U.S. data, Dr. Williams left no stone unturned, presenting extensive research that established the prevalence of racism in society, and the degree to which the experience of racial discrimination damages physical and mental health. Dr. Williams was joined on the stage by Uzma Shakir, Director of Diversity and Human Rights at the City of Toronto, and Naki Osutei, Director of Diversity and Inclusion for Toronto 2015 Pan/Parapan American Games. These local equity leaders brought a unique take on the discourse of racism on this city, and drew on their personal experiences to bring the issue to life. "The ongoing adversity of everyday discrimination, and the heightened vigilance that comes with it, wears the body down." - Dr. David Williams 2013 report 5

7 vulnerable populations racialized health inequity People Belonging to a Racialized Group Experience Poorer Health International research has found that people who belong to racialized groups experience poorer health than non-racialized group members. The term 'racialized' commonly refers to people of non-european ancestry, whereas the term 'non-racialized' refers to people of European ancestry. Studies have also shown that experiencing racial discrimination contributes to poor health. Toronto's ethno-racial diversity makes understanding racialization and health inequities in the city an important topic for public health action. In 2006, almost half of Toronto's population identified themselves as a member of a racialized group. This percentage is expected to increase. In 2013, Toronto Public Health released the report Racialization and Health Inequities in Toronto. The report presented Toronto-level data on racialization and health inequities, racial discrimination, socioeconomic inequities, access to healthcare, and health behaviours. Racialized group members in Toronto were almost twice as likely to be living in poverty compared to non-racialized group members. The results showed that: In 2006, racialized group members in Toronto were almost twice as likely to be living in poverty compared to non-racialized group members (33% vs. 17%) Between 2009 and 2011, racialized group members were almost two times more likely than non-racialized group members to report experiencing discrimination because of their race, ethnicity, or culture Some racialized groups experience poorer health compared to non-racialized groups Those who experience racial discrimination in Toronto have poorer physical and mental health compared to those who do not experience racial discrimination This evidence raises concerns about the health of racialized groups in Toronto if income inequities and experiences of discrimination persist. In November 2013, the report was presented to the Toronto Board of Health where members supported a number of recommendations aimed at improving data collection, increasing knowledge and awareness of the issue, reducing racialized socioeconomic inequities, reducing the prevalence of racial discrimination and addressing emerging evidence of racialized health inequities in Toronto. 6

8 living on a low income vulnerable populations Living on a Low Income: Connecting Public Transit and Health Public transit not only moves people, but also increases their access to employment, education, health and social services, food, and recreation which contribute to health. Although everyone benefits from transit, it is particularly important for people living on a low income who are often dependent on transit but may not be able to afford it. In 2006, commuters with the lowest income were 1.6 times more likely than the highest income commuters to use public transit to get to work in Toronto (43% vs. 27%). The current focus on transit expansion and investment both locally and provincially provide an unprecedented and important window of opportunity for Toronto Public Health to highlight the issue of transit affordability for low income residents in Toronto. In March 2013, TPH released Next Stop Health: Transit Access and Health Inequities in Toronto which examined public transit use in Toronto, disparities in transit affordability, the health impact of limited access to transit and strategies for improvement for low income residents. Since releasing the report, TPH has been focussed on increasing awareness of the importance of transit affordability for low income residents and building support for action in collaboration with community partners. Some of the key activities undertaken include convening a roundtable with local and regional stakeholders to discuss strategies to increase transit affordability such as reducing the cost of transit passes for low income residents and developing a backgrounder on affordable transit for use by groups across the province in the Ontario Poverty Reduction Strategy (OPRS) community consultations. TPH has also advocated for addressing transit affordability through the OPRS, Minimum Wage Advisory Panel and Transit Investment Strategy Advisory Panel consultations. Toronto Public Health will continue to work with other City divisions to explore strategies to address transit affordability for low income residents and will make recommendations to improve affordability to elected officials for decision-making. Commuters with the lowest income were 1.6 times more likely than the highest income commuters to use public transit to get to work. 7

9 vulnerable populations access to healthcare Advocating for Medically Uninsured Residents in Toronto Courtesy of Ministry of Health and Long-Term Care. Toronto Public Health has a long history of providing and advocating for healthcare services for all Toronto residents, including the medically uninsured. In 2013, Toronto Public Health continued efforts to ensure that people without provincial health insurance (that is, medically uninsured) have access to healthcare that will promote and protect their health, as well as the health of the entire population. Medically uninsured residents include people who have lost their identification, temporary visa holders, some refugees, undocumented residents and individuals who have recently moved to Ontario and are in the three month wait period for OHIP. Lack of access to healthcare negatively impacts health. Priority health needs for the medically uninsured population include: reproductive health, mental health, urgent care, communicable disease and chronic conditions. 8 Priority health needs for the medically uninsured population include: reproductive health, mental health, urgent care, communicable disease and chronic conditions. Healthcare options available to people who are medically uninsured are difficult to find and the healthcare system is complex to navigate. There are many barriers to accessing healthcare services including cost, language, discrimination and culture. Toronto Public Health provides healthcare to medically uninsured residents through the Community Volunteer Clinic in Scarborough and our TPH programs and services, which do not require an OHIP card. Medically Uninsured Residents in Toronto is the first comprehensive TPH report focussed on the medically uninsured population. The report built on advocacy work undertaken by TPH in response to federal changes to the Interim Federal Health Program. These changes reduced access to healthcare services for refugees and refugee claimants. The report includes recommendations that aim to increase access to essential healthcare for all uninsured residents and thereby reduce health inequities, including prioritizing children and youth, pregnant women, serious injury and urgent mental health needs. The report was adopted by the Board of Health and City Council. In January 2014, the Government of Ontario implemented a new program, the Ontario Temporary Health Program, to fill the gap left by changes to the Interim Federal Health Program. The Ontario Temporary Health Program provides access to essential and urgent healthcare and medication for refugees and refugee claimants living in Ontario, regardless of immigration status or country of origin. Toronto Public Health commended the Government of Ontario on this program, which will address the majority of issues that refugee claimants faced as a result of the federal cuts. More work needs to be done to ensure that all medically uninsured residents in Toronto have access to essential heathcare services. Toronto Public Health will continue to call on all levels of government to address this important issue.

10 smoking bylaws healthy living Strengthening Tobacco Laws in Toronto In December 2013, City Council endorsed important changes to Toronto's bylaws that expand smoking restrictions in outdoor public places. Smoking is now prohibited within nine metres of public building entrances and exits, sports fields, certain parks amenities, and in public squares and at swimming beaches. Toronto joins many Canadian municipalities in strengthening laws that restrict where people can smoke outdoors. These laws: Protect people from being exposed to the harmful effects of second-hand smoke; Support smokers to reduce or quit smoking altogether; and Reduce the visibility of smoking so it is less socially acceptable, particularly to children and youth. This success was possible through TPH's collaboration with Parks, Forestry and Recreation, Municipal Licensing and Standards and many stakeholders. TPH continues these partnerships to communicate and implement the bylaw changes, and to support other activities to help smokers quit or avoid starting. 38% of youth smokers tried to quit smoking last year.* Tobacco use in Ontario is responsible for an estimated $7.73 billion ly in healthcare and lost productivity costs. *Boak, A., Hamilton, H.A., Adlaf, E.M., & Mann, R.E. (2013). Drug use among Ontario students, : Detailed OSDUHS findings (CAMH Research Document Series No. 36). Toronto, ON: Centre for Addiction and Mental Health. 9

11 healthy living smoking cessation TPH Initiatives Support Smokers Trying to Quit Tobacco use remains the number one cause of preventable disease and death in Toronto. For approximately two million Ontarians, tobacco use is a chronic relapsing condition. While over half of smokers say they want to quit, healthcare providers often are hesitant to intervene and/ or have a limited awareness and use of available cessation services. The result is that over the last decade, there has been no statistically significant change in the proportion of adult smokers making attempts to quit smoking. Staff engage with the community at a display. Residents can Spin the Wheel to learn about tobacco cessation and the dangers of tobacco use. Tobacco kills 3X more Canadians each year than alcohol, AIDS, illegal drugs, car accidents, suicide and murder combined. In response, Toronto Public Health recently approved a new policy that requires all TPH staff to assess whether their clients use tobacco, advise them to quit, provide brief counselling and offer to connect them with Smokers' Helpline for information and counselling. The Tobacco Use Cessation Practice Policy and Procedure incorporates the use of Integrating Smoking Cessation Into Daily Nursing Practice, one of the Best Practice Guidelines (BPG) developed by the Registered Nurses Association of Ontario (RNAO). This BPG is being implemented by Toronto Public Health as a component of its Best Practice Spotlight Organization designation by the RNAO. By following the policy, TPH staff are making a valuable contribution to normalizing quitting behaviour. It is expected that this will lead to increased numbers of smokers making quit attempts and increased numbers of smokers who successfully overcome their dependence to nicotine to live tobacco-free. Smoking Treatment for Ontario Patients (STOP) STOP is a province-wide initiative that delivers free smoking cessation medication (nicotine replacement therapy/nrt) and counselling support to eligible Ontario smokers who wish to quit smoking. Since its inception in 2005, the STOP program has provided free smoking cessation medication and counselling support to over 100,000 Ontarians. STOP is funded by the Ministry of Health and Long-Term Care and administered by the Centre for Addiction and Mental Health. TPH staff continue to play an important role in promoting participation in STOP by eligible community agencies to increase the availability of counselling and effective medication in Toronto. STOP on the Road is a component of the STOP program implemented by public health units in which free NRT is dispensed to smokers at community workshops. Workshop participants receive a group presentation that provides information about tobacco dependence, strategies for quitting and on how NRT works to increase chances of success. In 2013, more than 200 people received counselling while they were being screened for eligibility to participate in STOP. Of these, 112 attended workshops and received a five week supply of free NRT to support their quit attempt. TPH is offering monthly workshops in community locations across the city beginning in May 2014 throughout the 2014/15 fiscal year. 10

12 empowering youth healthy living Be Your Best Self Toronto Public Health has created a youth-friendly digital hub called Be Your Best Self (BYBS) that not only shares health information, but provides a place to shape discussion and action around health issues that affect youth. The BYBS hub contains Facebook, YouTube and Twitter pages. One of these tools is a youth engagement initiative called Street Buzz where youth participants interviewed youth to discuss, advocate and take action on health issues that are meaningful to them. Content collected is shared on the BYBS and Toronto Public Health YouTube pages in order to engage with a larger youth population. In 2013, Toronto Public Health partnered with St. Stephen's House, The Remix Project and Verse City Ryerson School of Journalism for the initiative. TPH is also actively connecting with youth through its icanrelate interactive website which leverages social media to stimulate youth dialogue about relationships, highlighting issues such as assertiveness, jealousy, gender expectations, and emotions through social media. icanrelate In response to the needs of Toronto's youth, our Sexual Health Promotion staff developed the icanrelate project (icanrelate.ca). Focussed on communication skills for youth ages 15 25, icanrelate takes an innovative, upstream approach. It aims to bolster strengths, emphasize self-determination, and support young people in shaping their own relationships. icanrelate uses multiple social media platforms (Twitter, Facebook, YouTube, blogs) to engage youth on topics they have identified as most pertinent: conflict, jealousy, break-ups, and sexuality. Recent research shows that supporting youth relationships will reduce violence, harassment, relationship stress and sexually transmitted infections. icanrelate complements other TPH sexual health promotion initiatives including: education in schools, sexual health clinics, distribution of free condoms, support for parents and other healthy sexuality programming within the community. Embrace and love your body, it is the most amazing thing you will ever own. user on the icanrelate Twitter site 11

13 early childhood and family supporting healthy births New Online Program for Expectant Families Are you ready? Nervous? Excited? Every year there are approximately 31,000 births in Toronto. To meet the needs of pregnant women and their families, Toronto Public Health (TPH) offers a variety of prenatal education services. In November 2013, TPH launched a new online prenatal program "Welcome to Parenting the journey from pregnancy to parenthood." This complements the existing individual service and group based Canada Prenatal Nutrition Program (CPNP) and is available for free to all expectant families living in Toronto. The online prenatal program, which can be found at toronto.ca/ health/pregnancy, supports TPH's goal to promote and support healthy pregnancies and birth outcomes. These goals are supported by Ontario Public Health Standards (OPHS) for Reproductive Health (2008), as well as TPH's strategic plan ( ) priority direction of delivering services that meet the needs of Toronto's diverse communities. "It is great and a wealth of information for me." online prenatal program participant Welcome to Parenting, is comprised of 29 interactive classes that include video, audio, games and quizzes. The program provides parents-to-be with the knowledge, skills and confidence to prepare for labour, birth and the transition to parenting. The online prenatal program's goal is to reach a wider audience than traditional in-person programming. Online learning removes physical barriers (e.g., transportation, childcare) as well as time constraints (e.g., users are able to access the program according to their own schedules). Designed as a self-directed program, it emphasizes autonomy and independence as the user can control the content reviewed and the pace of learning. Over the first four months of implementation (November 2013 February 2014), the online prenatal program has registered 596 participants. Feedback about the online prenatal program has been very positive: "It is great and a wealth of information for me." "These pregnancy support ads make me proud to live in this city." "We're excited about this new prenatal program and cannot wait to promote it to our clients." 12

14 baby-friendly initiative early childhood and family TPH Champions Baby-Friendly Designation Toronto Public Health's (TPH) goal is to promote a baby-friendly environment by providing programs and services that protect, promote and support breastfeeding as the normal way to feed infants and young children while supporting the infant feeding choices of all families. In support of this goal TPH received the prestigious Baby- Friendly Initiative (BFI) designation in January BFI is a global campaign of the World Health Organization and UNICEF to protect, promote and support breastfeeding and to improve health outcomes for mothers and babies. TPH is the largest community health service in Canada to receive this prominent award. One of the aims is to support mothers to breastfeed exclusively and for as long as they wish to, says Olga Jovkovic, Healthy Families manager at TPH. BFI designation ensures that Toronto residents receive high quality infant feeding services. Families are supported to make informed decisions about infant feeding. Appropriate care and support are given to families regardless of their feeding decision. Following the release of the Board of Health report entitled: Breastfeeding in Toronto: Promoting Supportive Environments (March 2010), TPH began a concentrated effort to achieve BFI designation. Efforts focussed on four key areas: staff training related to key BFI concepts; ensuring resources met BFI standards and adhered to The International Code of Marketing of Breast-Milk Substitutes; data collection to determine current breastfeeding rates and policy development which outlined staff roles and responsibilities related to BFI. BFI Champions were also identified within the Healthy Families directorate to support and promote BFI within TPH and in the community. The Ontario Public Health Standards require health units to use a comprehensive health promotion approach to increase the rate of exclusive breastfeeding rates to six months. BFI designation is an indicator of achievement related to this standard. As such, the Ministry of Health and Long-Term Care requires each health unit, as part of their accountability agreements with the province, to achieve and maintain BFI designation. TPH is currently working on a BFI sustainability plan to ensure successful re-designation in TPH is the largest community health service in Canada to receive BFI designation. 13

15 early childhood & family nutrition screening Eating Well: Nutrition Screening for Toddlers and Pre-Schoolers Good nutrition is critical for a child s, physical, social and mental growth and development and learning. Yet, approximately 10 20% of the population of young children aged 18 months to five years will be identified at high nutritional risk. To ensure that toddlers and pre-schoolers get the best possible start, TPH offers parents a simple and reliable screening tool to assess their child's eating habits and alert them to the risk of possible nutritional problems. Property of the Sudbury & District Health Unit and used with permission. The NutriSTEP (Nutrition Screening Tool for Every Pre-schooler) screening tools consist of 17 questions each, one set of questions for toddlers and another for pre-schoolers. The questions ask about a child s food and nutrient intake, physical growth and development, physical activity and eating environment, including a caregiver s ability to buy and access food. Approximately 10-20% of the population of young children aged 18 months to five years will be identified at high nutritional risk. Sudbury & District Health Unit The questionnaire is designed to be completed by the child's parent or primary caregiver. After parents complete the questionnaire, TPH nurses provide them with nutrition information, resources and referrals based on the needs of their child. Toronto Public Health is actively partnering with local community agencies interested in setting up screening clinics at their agency. Training and access to the tools are provided to interested agency staff at no cost. Parents and trained community partners can get copies of the screening questionnaire and information about training opportunities by calling Toronto Health Connection at Poor nutrition in young children can lead to: Growth problems such as failure to thrive and obesity Anemia Poor eating habits that become lifelong Lack of school readiness Inability to learn at school Nutrition screening provides: Early identification of potential nutrition problems Parent referral to community resources Parental nutrition education Support in evaluating pre-school nutrition interventions A means of monitoring community child nutrition programs 14

16 menu labelling health protection Menu Labelling: Making People Savvy Diners Torontonians are eating out more than ever before and studies show that diners underestimate the calories and sodium in their restaurant meals. In April 2013, the Toronto Board of Health and Toronto Public Health joined a long list of organizations and health experts calling for the Government of Ontario to legislate larger chain restaurants to post calorie and sodium levels on the menu or menu board. Without a regulatory approach, nutrition information is virtually never posted right on restaurant menus where people are much more likely to see it and use it. Research shows that there is strong public support for menu labelling in Toronto and Ontario. TPH developed an innovative social engagement campaign strategy that would capitalize on the existing public support for menu labelling. The Savvy Diner campaign ( ) was launched in June The goals of the campaign were to raise awareness about the need for menu labelling with calorie and sodium information, and to enable Toronto residents to demonstrate their support for menu labelling. Staff contributed over 60 blog posts and over 100 posts on Facebook. The staff time dedicated to this social engagement strategy paid off. By December, over 14,000 people who had visited the website clicked their support for menu labelling on the site, and over 2,650 people had "liked" the campaign on Facebook. The growing Savvy Diner brand will be extended to future TPH actions to promote healthy eating out environments. In February 2014, Health Minister Deb Matthews tabled a new menu labelling bill that would require restaurants, fast-food outlets, supermarkets and convenience stores with 20 or more sites in Ontario to post calories on menus. Should the legislation pass, Ontario will be the first province in Canada to require calorie counts visible to the public. TPH continues to urge the government to also legislate sodium values on the menu. The average sit-down restaurant meal has more than half the calories needed in a whole day report 15

17 health protection bodysafe Regulation of Tattooing and Body Piercing Toronto residents can now view Pass, Conditional Pass and Closed inspection notices similar to DineSafe notices at all personal services settings (PSS) including hairdressing salons and barbershops across Toronto. As part of this inspection and disclosure program, Toronto Public Health launched a new website called BodySafe for inspection results and for complaints about hair salons, tattooing, micropigmentation, ear and body piercing, electrolysis, manicure, pedicure and aesthetics services. The BodySafe program ensures that PSS owners/operators use safe practices when providing services to prevent the spread of infections. The purpose of the BodySafe program is to ensure that PSS operators use safe practices when providing these services to prevent the spread of infections such as hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and other fungal and bacterial infections. All PSS inspection results will remain on the website for two years. The website launched in July 2013 in conjunction with changes to Toronto Municipal Code 545, Licensing which came into effect the same month. The bylaw requires any PSS to be licensed in order to operate in Toronto. With this bylaw in place and the BodySafe website now available, the public can make better informed decisions about visiting these premises. 16

18 immunization health protection Toronto Unvaccinated: The Rising Spread of Vaccine Misinformation Impact of Vaccines in Canada Vaccines have saved the lives of more people than any other public health or medical intervention in the last 50 years. Broad public acceptance of vaccinations over time has virtually eliminated or significantly reduced most infectious diseases prevented by vaccines. Now that vaccine preventable diseases are rarer, parents have become less fearful of them, and some are choosing to delay or refuse vaccination for their children. The rising spread of vaccine misinformation has also contributed to parental confusion, fear and vaccine hesitancy. A Board of Health report, Toronto Unvaccinated: The Impact of Vaccination on the City s Health, released in April 2013, warned that if children in Toronto are not vaccinated against previously common childhood diseases, Toronto will see a large increase in these diseases, with associated complications and deaths. The report models the risk of infection and harm to children if parents gradually stopped immunizing their children against measles, whooping cough (pertussis) and polio. The model showed that if vaccination rates decline, hundreds to thousands of people could become ill, as seen in the large measles outbreaks in Europe and pertussis outbreaks in the United States. A 2013 outbreak of measles in a daycare among five unvaccinated children in Toronto illustrated that pockets of unvaccinated children are highly vulnerable to vaccine-preventable diseases. This example, and the results of the Toronto Unvaccinated report, affirm the importance of bolstering public confidence in vaccines and maintaining high vaccination rates to maintain protection against contagious and deadly diseases. 17

19 healthy environments urban agriculture TPH Guide Wins National Award for Helping Transform Urban Spaces Into Places to Grow Toronto Public Health's "must have" guide for testing soil in urban gardens won a Brownie Award for its leadership, innovation and commitment to urban revitalization across Canada. The guide entitled: From the Ground Up Guide for Soil Testing in Urban Gardens won the national award from the Canadian Urban Institute (CUI). The initiative won in the Category 1: Legislation, Policy and Program Development. For the project TPH collaborated with Parks, Forestry and Recreation, and the former Toronto Environment Office and formed 20 partnerships and collaborations to support the development of the guide which was released in October This is exactly what Toronto needs to promote more urban food-growing at all scales." - Dr. Wally Seccombe, Co-founder and Chair of Everdale. FoodShare TPH developed the guide for assessing soil safety for gardening and growing food. The goal of the initiative is to increase the number of urban gardeners and to expand the available land base available to them by providing the tools and information they need to make healthy choices about growing food in urban soils. It is a 'must have' document that is used in part of setting up any community garden, said Susan Berman, Toronto Community Garden Network. Dr. Wally Seccombe, Co-founder and Chair of Everdale, said, "This is exactly what Toronto needs to promote more urban foodgrowing at all scales." Everdale 18

20 environmental response healthy environments Responding to Contamination Threats to Health TPH's Environmental Response Team respond to environmental health contamination issues that impact soil, water and air. In 2013, the team: Provided support to the front line Health Hazard investigation teams on the more complex and technical environmental health issues received by TPH each year Provided public health advice on the redevelopment of contaminated lands Responded to politicians and communities concerned about local environmental health issues Assisted other City Divisions/Agencies in dealing with contamination issues Provided Public Health advice on demolition permit applications where designated substances are present in the buildings Responded to reports of non-infectious, chronic disease clusters Developed response plans to emerging environmental health issues Created policies, procedures and facts sheets on environmental issues The team reviewed and provided public health comments on 118 demolition permit applications requiring the provision of dust control plans and control measures in the handling of designated substances. The team also provided TPH input into the cleanup of contaminated sites. Work was also undertaken jointly with the Toronto District School Board in dealing with issues raised by parents and teachers. This included soil contamination at Portage School and Central Technical School and air quality concerns at Waterfront School related to the expansion of Billy Bishop Airport. The Environmental Response team worked jointly with the Toronto District School Board in dealing with issues raised by parents and teachers. In 2013, the team responded to 84 enquiries relating to electromagnetic fields and radio frequency issues. In collaboration with Toronto Water, work was also undertaken by the team to raise awareness about the risk of pneumonia-causing Legionella bacteria for owners/operators of cooling towers within the city report 19

21 healthy environments climate change Preparing for the Public Health Impacts of Climate Change For many the words climate change still evoke images of melting snowcaps and polar bears stranded on ice floes. But what if the conversation about the impacts of climate change was instead about increased illness from exposure to heat, more illness from food contamination, increased respiratory problems and even displaced families? That s what Toronto Public Health (TPH) is hoping to achieve as it works to draw more attention to the impacts that climate change could have on the population's health. For example, Toronto's climate modelling suggests that by 2049, Toronto could experience more frequent severe rainstorms, and more than triple the number of days with temperatures exceeding 30º C. Examples of populations that are more sensitive to external stresses include the elderly and isolated groups, children, and those with pre-existing illnesses. TPH released a research report in 2013 on the potential health and social impacts of climate change which include: more illness and death from extreme heat, poor air quality, an increase in bacterial and viral diseases transmitted by mosquitoes, ticks and fleas, a jump in illness and injury arising from flooding of homes and businesses, and impacts on mental health. Increases in extreme weather could also have significant impacts on factors that indirectly affect health including food security, social networks, employment status, quality of housing, income and access to health services. While extreme weather is likely to test the resilience of all populations, the ability of some groups to cope with such weather events may be especially limited. Some people are more likely to experience adverse impacts either because they are more likely to be exposed to the health risk, or because they are less able to cope with the fallout of an extreme weather event. Examples of populations that are more sensitive to external stresses include the elderly and isolated groups, children, and those with preexisting illnesses. These vulnerabilities to extreme weather may add to significant health inequalities that have already been documented in Toronto. As a result of these findings, TPH is now planning a comprehensive assessment of Toronto's vulnerability to health and social impacts of climate change. This work will support efficient, effective service delivery and protection of health in a changed climate. Once the appropriate research and partnerships are in place, TPH will work to identify opportunities for strengthening the resilience of Toronto's population, especially the most vulnerable groups. 20

22 funding public health budget In 2013, the Government of Ontario provided funding for 71 percent of the TPH gross operating budget with 21 percent contributed from the City of Toronto and the remaining 8 percent from user fees and other divisions in the City. The cost sharing formula of 75:25 for most public health services means that every $4 of services requires only $1 of investment by the City. TPH 2013 Approved Operating Budget by Funding Source ($000s) Table 1 below shows the cost of public health services per Toronto resident since The shift in the provincial formula starting in 2004 from 50 percent to 75 percent provincial funding for cost-shared programs has allowed the City to move significant property tax dollars from public health into other City programs. The 2013 Approved Operating Budget includes $16.5 million less in municipal tax funding than in The 2013 Approved Operating Budget costs each Toronto resident $19.39 in property taxes for public health services. Table 1 Public Health Cost for Each Toronto Resident ($) The increase in 2013 is the result of enhancement to the student nutrition program of $1.4 million. City Tax Funded $50, % Provincial Grants, other Revenue Sources $193,095 79% The Approved TPH 2013 Gross Operating Budget totals $243.5 million and includes funding for 1,875 staff. TPH 2013 Budget by Program ($000s) Environmental Health 24, % Emergency Preparedness 2, % PH Foundations 18, % Chronic Diseases & Injuries 41, % Infectious Diseases 65, % Family Health 90, % 2013 report 21

23 Toronto health indicators Monitoring the Health of Toronto Toronto Public Health is responsible for monitoring, assessing, and reporting Toronto's health status. The following table and charts present the most recent estimates for selected health statistics. Overall, Toronto's health compares favourably to the rest of Ontario. Infant mortality, low birth weight, and physical activity however, are exceptions. The estimates presented here for Toronto, vary across the city with poorer health often being associated with lower income and other determinants of health. Population (2011): 2,615,000 Births (2011): 30,500 Deaths (2009): 16,566 Health Indicator Estimate / Value Data Year Teen Pregnancy Rate 25.4 pregnancies per 1,000 females 15 to 19 years 2011 Low Birth Weight Babies (Singleton) 5.9% 2011 Infant Mortality 6.4 infant deaths per 1,000 live births 2009 Children Vulnerable in Terms of Readiness to Learn (in senior kindergarten) 29.9%* 2010/11 Youth Smoking (grades 7 to 12) 9.9% 2013 Adult Smoking (ages 20 and older) 17.1% 2011/12 Daily Vegetable and Fruit Consumption (5 or more times per day, ages 20 and older) Physically Active and Moderately Active (ages 20 and older) 36.4% 2011/ % 2011/12 Overweight / Obese (ages 20 and older) 45.8% 2011/12 Diabetes Prevalence (ages 20 and older) 8.5% 2011 Life Expectancy Males 78.7 years 2009 Health Adjusted Life Expectancy Males 70.3 years 2009 Life Expectancy Females 82.5 years 2009 Health Adjusted Life Expectancy Females 70.3 years 2009 *The methodology used to calculate this estimate has been modified from previous years; thus the estimate is not comparable to earlier published values. Data sources and related notes are available at: /statistics An expanded set of health indicators for Toronto is available at: /map/indicators/index 22

24 health indicators Toronto Age-Standardized Mortality Rate* for Leading Causes**, Toronto, 2009 *Rates are age-standardized to the 1991 Canadian population. **Leading causes of death are based on a standard list developed by Becker, et al. (2006) for the World Health Organization that was modified by the Association of Public Health Epidemiologists of Ontario in Data Sources: Vital Statistics, 2009, Ontario Ministry of Health and Long- Term Care, IntelliHealth Ontario, Date Extracted: August 2012 Number of Deaths for Leading Causes**, Toronto, 2009 **Leading causes of death are based on a standard list developed by Becker, et al. (2006) for the World Health Organization that was modified by the Association of Public Health Epidemiologists of Ontario in Data Sources: Vital Statistics, 2009, Ontario Ministry of Health and Long- Term Care, IntelliHealth Ontario, Date Extracted: August

25 public health communications A look back at the top public health issues in media/social media TPH Twitter followers have increased rapidly since our account was created in 2010 including doubling in 2013! Average growth Followers per month

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