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Toronto Toronto’s top medical official clashes with Doug Ford’s Ontario government over public health cuts

Toronto's Medical Officer of Health Dr. Eileen de Villa speaks to the media at city hall in Toronto, on Wednesday, April 24.

Christopher Katsarov/The Canadian Press

When the Doug Ford government decided to cut funding to Ontario cities for public health, it must have expected local politicians to protest. What it might not have reckoned on is the soft-spoken grit of a civil servant.

Eileen de Villa, Toronto’s Medical Officer of Health, has emerged as a leading voice against the cuts, which have hit the country’s largest city as it is struggling with a wave of deaths from the opioid crisis.

The Progressive Conservative government announced just before the Easter long weekend that it was reducing public-health transfers to municipalities around the province. Toronto figures it will lose a billion dollars over 10 years. Dr. de Villa was one of the first to speak out, saying she was “extremely disappointed” and that the cuts would have “significant negative impacts” on the health of Toronto residents.

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“Whether it is providing school immunization programs, protecting people from measles, influenza, the next SARS and other outbreaks, helping keep our water safe to drink, inspecting our restaurants, pools and beaches, investments in public health keep our city and residents safe, healthy and strong,” she said in a statement.

On Wednesday, after Health Minister Christine Elliott defended the cuts against what she called “fear-mongering” attacks, Dr. de Villa spoke out again – evenly and moderately. Flanked by several people who told stories about how public health had helped them during their struggles with illness, she told a City Hall news conference that investing in public-health services actually saves governments money by heading off costly disease and ill health.

It was the second time in a month that Dr. de Villa has objected to a decision by the government. After Mr. Ford’s government said it was cutting funding to some safe-injection sites around the province, including two in Toronto, she said “I expect you will see deaths. I don’t think that’s hyperbole, nor do I think that’s exaggeration. I think it’s calling the facts as they are.”

Dr. de Villa comes by her outspokenness naturally. Her parents, both doctors, were vocal critics of Philippine strongman Ferdinand Marcos. Her mother, a cardiologist, and father, an obstetrician and gynecologist, left the Philippines in the 1970s to escape the Marcos regime.

After what Dr. de Villa admits were some pretty surly teenage years when she bridled at the idea of following in their footsteps, she started collecting university degrees: in science from McGill, in health science and then medicine from the University of Toronto, even in business from York. Internships with the United Nations got her interested in public health.

After working in Peel Region just west of Toronto, she became the head of Toronto’s health department in March, 2017. She quickly realized she was facing what she calls “the defining health issue of our time” – the opioid crisis.

Opioid deaths compared to deaths

from three other major health crises

Number of annual deaths, Canada

Opioids (2017): 4,000

=

40 deaths

AIDS in 1995:

2,000

H1N1 in 2009:

400

SARS in 2003:

44

MURAT YÜKSELIR / THE GLOBE AND MAIL

Opioid deaths compared to deaths

from three other major health crises

Number of annual deaths, Canada

Opioids (2017): 4,000

=

40 deaths

AIDS in 1995:

2,000

H1N1 in 2009:

400

SARS in 2003:

44

MURAT YÜKSELIR / THE GLOBE AND MAIL

Opioid deaths compared to deaths from three other major health crises

Number of annual deaths, Canada

Opioids (2017):

4,000

AIDS in 1995:

2,000

H1N1 in 2009:

400

SARS in 2003:

44

=

40 deaths

MURAT YÜKSELIR / THE GLOBE AND MAIL

Google her name and you will find a recent talk she gave. She begins: “What if I told you that every month in Canada an airplane full of people crashed and everyone on board was killed.” That, she says, is how many people are dying from drug overdoses: more than 300 a month, as many as might perish in the crash of a passenger airliner. In Toronto alone, paramedics reported 22 deaths from suspected overdoses in March.

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So, Dr. de Villa was quick to challenge the government when it stopped funding certain supervised injection sites. When people use drugs under the supervision of trained staff instead of alone in alleyway or a washroom, she says, they are less likely to suffer a fatal overdose. The site her organization, Toronto Public Health, is running just downstairs from her office has reversed 800 overdoses since opening on Nov. 9, 2017.

“When she says something so direct such as there ‘will be deaths,’ you know with her that it is not conjecture or exaggeration,” says Joe Cressy, a Toronto city councillor who chairs the city’s board of health and has joined her to criticize the public-health funding cuts. “It is solidly based in fact and research and that’s what makes her so powerful as a conscience for our city. She doesn’t yell fire unless there’s a real fire.”

That approach – base actions on facts – governs everything Toronto’s senior public-health official does. It is behind her vocal support for the supervised injection sites. It is behind Toronto Public Health’s call for a campaign against misinformation about the safety of vaccinating children. And it was behind her headline-making call for the decriminalization of all drugs for personal use.

When she released a report on the issue last summer, she said that “our belief, based on the evidence, is that the criminalization of people who take drugs actually is contributing to this opioid-overdose emergency in our city, because it forces people into unsafe drug practices and actually presents a barrier to those who might be interested in seeking help for addressing opioid-use disorders.”

She is guided, she insists, purely by the data. “My job,” she said in a recent interview in her Toronto office, “is to make sure we bring the best science, the best evidence that exists out there, to the situation we see here in Toronto.”

That gives her complaints about the government’s cuts to public-health funding more force than they might have coming from a politician. Responding to attacks on the cuts by Mr. Cressy and others, Robin Martin, the Parliamentary Secretary to the Health Minister, told CP24 television on Wednesday that their remarks were “overinflated,” “inflammatory,” “reckless” and “irresponsible.”

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It is hard to say that about Dr. de Villa, who is the mother of three teenage boys. She says she is not criticizing the government at all, just making sure that its decisions are “well-informed and evidence-based.”

On Wednesday, a reporter asked her about a remark by Mr. Ford. The Premier had phoned a Global News radio program on Monday and was asked about the health-funding cuts. He said: “Those are the folks that go around and go into restaurants and put the little sticker saying it’s safe to eat here.”

Asked Wednesday if she thought Mr. Ford had any idea what public-health officials do, Dr. de Villa would not be drawn. “I’m not sure what the Premier understands of public health,” she said, but it’s easy to think it is worthless because when it works “what happens is nothing. There is no outbreak, there is no illness.” Instead, people are “healthy, happy, safe and thriving.” So, “that’s an incredibly valuable nothing.”

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