Item - 2016.HL14.4

The Board of Health recommends that:

1.  City Council increase funding to the three 24-hour drop-in sites to upgrade and improve their facilities for the 2016/2017 winter season.

The Board of Health:

1. Supported in principle the expansion of continuous 24-hour drop-in service by the Shelter, Support and Housing Administration Division to better protect the health of people experiencing homelessness during the cold season. This expansion could include extending the availability of the continuous 24-hour drop-in service by two weeks and, if feasible, adding a third, overnight drop-in site, such that all three operate from December 15 to February 28 with alert-based services for the remainder of the November 15 to April 15 cold season;

2. Forwarded the report (September 12, 2016) from the Acting Medical Officer of Health to:

a. The General Manager of Shelter, Support and Housing Administration, the Executive Director of Municipal Licensing and Standards, the Director of the Toronto Office of Emergency Management, the General Manager of Toronto Parks, Forestry and Recreation, the Director of the Environment and Energy Division, Toronto Community Housing Corporation, Toronto Police Services, Toronto Paramedic Service, and Toronto Transit Commission for their information and follow-up as appropriate; and

b. The Centre for Urban Health Solutions (C-UHS), Street Health, Toronto Community Health Centres, Sherbourne Health, Community Care Access Centres, Public Health Ontario, Environment Canada, Health Canada, Association of Local Public Health Agencies, Canadian Public Health Association, Ontario Public Health Association, Toronto District School Board, Toronto Catholic District School Board, Ontario Medical Association, and Registered Nurses Association of Ontario for their information.

There is strong evidence that cold weather can affect the health of all members of the population, and is a particular risk for people who are experiencing homelessness. Toronto Public Health coordinates Toronto's Cold Weather Plan, which aims to prevent harmful health impacts of cold weather on residents of Toronto. The Plan is a living document which is updated as new information becomes available.

New research shows that in Toronto, cold-related injuries are most common from mid-December to the end of February. Extremely cold temperatures such as those that currently trigger Toronto's Extreme Cold Weather Alerts are linked to the highest risk of cold-related injuries in Toronto. When temperatures are moderately cold (i.e., when temperatures are -15 °C or warmer), the risk is lower, but compounds over time. This means that most cold-related injuries in Toronto occur at times when Extreme Cold Weather Alerts are not in place. Interviews with people experiencing homelessness found that throughout the winter their health is also affected by precipitation, changes in temperature, high occupancy in shelters, anxiety, stress, and worsening of pre-existing conditions.

The findings suggest that cold weather response in Toronto should have multiple components: 24-hour continuous drop-in services during the period of greatest health risk for those most vulnerable, alert-based response on extremely cold days as they occur, and messaging and actions to address health risks that persist throughout the winter.

In 2015-2016, Shelter, Support, and Housing Administration (SSHA) partnered with two community agencies to offer continuous 24-hour cold weather drop-in services for January and February, with alert-based drop-in services offered during the remainder of the cold season. For 2016-2017, SSHA will seek approval to advance the start date for continuous services to mid-December to better correspond with the period of greatest risk for cold-related injuries, and is planning a third site, if feasible, to assist with service demand.

This report was prepared in collaboration with Toronto's Shelter, Support and Housing Administration Division.