Item - 2015.HL7.3

City Council re-opened Item CD4.4 for further consideration only as it pertains to the funding for cold weather drop-in services in 2016.

City Council considered Items HL7.3 and CD7.3 together.

The Board of Health recommends that:

1. City Council, on an interim basis, authorize the Deputy City Manager and Chief Financial Officer to provide one-time funding from the Emergency Human Service Reserve Fund, in order to implement continuous 24-hour cold weather drop-in services for January and February 2016. 

3.  Requested the Medical Officer of Health to report back to the Board of Health on further research and analysis, conducted in collaboration with Public Health Ontario, on the health impacts of cold weather on Toronto's general population, focusing particularly on vulnerable groups such as the elderly and individuals with pre-existing medical conditions;

4.  Requested the Medical Officer of Health to develop evidence-based messaging to inform Toronto's general population of the health risks associated with cold-weather and the precautionary actions that should be taken during periods of extreme cold to reduce the likelihood of developing cold-related injuries;

5.  Requested the Medical Officer of Health to report to the Board of Health in the early fall of 2016 on the Cold Weather Protocol for 2016-2017, such report to further review global best practices; and

6.  Forwarded the report (October 5, 2015) from the Medical Officer of Health to Shelter, Support and Housing Administration, Municipal Licensing and Standards, Toronto Office of Emergency Management, Toronto Parks Forestry and Recreation, Community Care Access Centres, Public Health Ontario, Environment Canada, Health Canada, the Director of the Environment and Energy Division, Association of Local Public Health Agencies, Canadian Public Health Association, Ontario Public Health Association, Toronto District School Board, Toronto Catholic District School Board, Toronto Police Services, Toronto Paramedic Service, Ontario Medical Association, and Toronto Transit Commission.

Cold weather can have a substantial impact on health and well-being. Exposure to periods of cold weather is of particular concern to certain groups including people with pre-existing illnesses, the elderly, children and homeless populations. People experiencing homelessness are especially vulnerable to the effects of cold due to the extended period of time spent outdoors, especially over the winter when temperatures are regularly below freezing.

To protect the homeless population from the harmful health impacts of cold weather, the City of Toronto has developed a Cold Weather Response Plan. The Plan is maintained and updated by Toronto Public Health (TPH) and provides a framework for implementing and co-ordinating cold weather response activities. These activities include issuing an Extreme Cold Weather Alert, which triggers response activities co-ordinated by Shelter, Support and Housing Administration targeted at people experiencing homelessness.

This report reviews emerging information about the impact of cold weather on health to determine whether any changes to the way Extreme Cold Weather Alerts are issued are warranted. This is based on input from a cold-weather workshop attended by key stakeholders, findings from a collaborative study between St. Michael's Hospital and TPH, and new evidence from the scientific literature. These findings support maintaining the current threshold for issuing an Extreme Cold Weather Alert when Environment Canada forecasts a temperature of -15°C or colder or a wind chill of -20 or colder, taking into consideration other environmental factors which may affect health risk.

Emerging research also supports earlier findings that people experiencing homelessness are at increased risk of cold-related morbidity, particularly from injuries such as frostbite and trench foot. In a Toronto study, the majority of these injuries were found to occur in January and February when temperatures are at their lowest. This finding supports enhanced 24- hour cold weather drop-in services for January and February as proposed by Shelter, Support and Housing Administration (SSHA).

Cold weather can also have a substantial impact on the health and well-being of the general population. People aged 65 or older and individuals with pre-existing cardiovascular illnesses are particularly vulnerable to the impacts of cold-weather. Research from Public Health Ontario (PHO) shows an increase in cardiovascular mortality in Toronto during the winter season. Based on this emerging research, TPH and PHO will conduct collaborative research on the health impacts of cold weather on Toronto's population to better understand the groups at risk. Furthermore, TPH will develop evidence-based messaging to inform the general population of the health-risks associated with cold-weather and precautionary actions that can be taken to reduce the likelihood of developing cold-related injuries.