‘Time for change’: Toronto launching service to respond to mental health crisis calls

From the Toronto Star article

TORONTO – When a mental health crisis call comes in to 911 in certain parts of Toronto next month, a team typically consisting of two people such as a harm-reduction worker and a nurse, or an Indigenous elder and a de-escalation expert – not police – will be the first to respond.

The mobile unit will meet with the individual in crisis and figure out what they need. Response teams will then check on the person within two days and help arrange further support, such as long-term counselling, as required.

It’s all part of a new approach to crisis intervention in Toronto that’s beginning with a pilot program launching in a few weeks.

The City of Toronto – which plans to eventually implement the program in all neighbourhoods – describes the effort as a community-led, trauma-informed alternative to traditional crisis response, with a focus on reducing harm and preventing problems from arising.

Dr. Andrew Pinto, a family physician at St. Michael’s Hospital in Toronto, said a community-led approach to helping people in mental health crises is “long overdue” and has the potential to save lives.

Pinto said it could lead to more support for those who live with mental health concerns and could prevent cases where they are harming themselves or others. In the long term, he said it can help people engage with health and social care and other resources.

Since police won’t be going to confront someone who’s in a mental health crisis, the risk of “police committing violence and actually killing somebody” could also be reduced, he said.

“I think that this type of approach can make a difference for folks. And I think that a really rigorous evaluation will help confirm (that),” Pinto said.

‘My mom is not the only person COVID has killed this week.’ Who is still dying from the virus in Ontario?

From the Toronto Star article

While dropping mask mandates and vaccination passports in Ontario may be a sign the worst of the pandemic is behind us, a steady stream of deaths from COVID-19 — 366 in the last month alone, according to the province’s latest data — is a reminder that the province has yet to escape the deadly virus.

The same week the province removed mandatory masking, Ontario saw 56 COVID deaths including Thompson’s, primarily in people over the age of 60. And in the three weeks since the province ended its proof-of-vaccination program, 329 people have died.

Dr. Sharmistha Mishra, an infectious disease physician and mathematical modeller at St. Michael’s Hospital, a part of Unity Health Toronto, said tracking COVID deaths is critical for understanding the pandemic — and to guide policy changes to help prevent more people from dying.

She and her team have analyzed COVID deaths and hospitalizations and found the disease disproportionately impacts those living in the province’s lowest-income neighbourhoods.

“This suggests our (COVID) interventions are working for higher-income neighbourhoods. But they are not reaching those who live in the lowest-income neighbourhoods,” she said.

This stark trend continued into the fourth and fifth waves and is apparent even when accounting for underlying health conditions, said Mishra, who holds a Canada Research Chair in Mathematical modelling and Program Science.

In Waves 4 and 5, the 20 per cent of the Ontario population who live in the highest-income neighbourhoods died of COVID at half the rate as compared to the 20 per cent of the population who live in the lowest-income neighbourhoods. This is according to data analyzed by Mishra and presented in the Ontario COVID-19 Science Advisory Table’s March 17 update.

“When you look at this data, it begs the question: for whom have we flattened the curve?,” said Mishra, noting access to testing and COVID therapeutics that can be administered out of hospital, such as monoclonal antibodies, is likely more limited for those in the province’s lower-income neighbourhoods, a point public health officials and policy-makers must consider in the months ahead.

“Deaths hold us accountable … in broad strokes they show us that we have continued to leave communities behind in this pandemic.”

Walkability and Redlining: How Built Environments Impact Health and Perpetuate Disparities

From the AJMC article

Built environments can shape how active an individual is, while policy decisions made decades ago impact health disparities today. To address these critical social determinants of health, experts are calling for increased cooperation between urban planners and the public health field.

In the world of real estate, location is everything, serving as a major driving force behind both rent prices and mortgage rates. But a growing body of research highlights that when it comes to health outcomes, location may also affect disease risk, and where you reside can impact how you live.

One analysis included in the review revealed that between 2001 and 2012 in Ontario, Canada, higher neighborhood walkability was associated with a stable prevalence of overweight and obesity, and decreasing diabetes incidence. By 2012, all 3 rates were significantly lower compared with less walkable areas, where levels of obesity continued to rise.2

But geographic and population density alone does not account for this association, as destinations also influence the advantages of neighborhood walkability, explained Gillian Booth, MD, MSc, of the Department of Medicine at University of Toronto in an interview with The American Journal of Managed Care® (AJMC®).

Booth is a scientist at the MAP Centre for Urban Health Solutions within the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and coauthor of the aforementioned studies.

Factors outside of design, density, and destinations affect neighborhood-specific health outcomes, and can even negate the benefits of living in highly walkable areas, she stressed.

Based on their research, Booth and colleagues found those living in areas with low levels of traffic-related air pollution reaped greater benefits from walkability with regard to hypertension and diabetes risk.

“But if there [were] really high concentrations of air pollution, the benefit of walkability was completely eliminated, because air pollution itself is a risk factor for diabetes,” she said. “It’s not enough to just build [environments] right.”

Apart from pollution, additional influences can sway the extent to which individuals take advantage of walkability and the neighborhood’s capacity to enact environment-level improvements. Safety, sidewalk conditions, crime rate, and transportation options all function to encourage or dissuade walking, regardless of a space’s design.

“We always have to think about where people live and the neighborhood environment as a whole, and what makes the neighborhood healthy and what doesn’t,” Booth said. “There’s a lot of interest now into, not only how do we make healthier designs, but about how do we make more equitable decisions in terms of where to invest.”

Pharmacare announcements do not guarantee lower drug prices

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Op-ed in the Toronto Star by Dr. Nav Persaud

Pharmacare announcements have not made people healthier before. The confidence-and-supply agreement between the Liberals and NDP promises only a plan for pharmacare by 2025. So we will hear more announcements about pharmacare, but will medicines ever be included in our publicly funded health system?

Money is the reason dental care was promised but pharmacare was not. Pharmacare will save billions of dollars by reducing the price for each pill. The current patchwork system ratchets up drug prices as private insurance companies, which provide employer-based plans enjoyed by around 60 per cent of Canadians, take a percentage of each claim. So high drug prices are incentivized in Canada where medicines are less expensive in countries such as New Zealand, Australia and the United Kingdom.

Lower prices were supposed to arrive in Canada. Five years ago the Trudeau government promised to tackle high prices for patented drugs by using prices in countries like New Zealand to set price ceilings. Implementing this change was supposed to be a step toward pharmacare. Five years ago then-Health Minister Dr. Jane Philpott said “Canadians are going to see that we are going to be able to save [them] in the order of billions of dollars per year.”

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L’annonce du programme d’assurance médicaments ne garantit pas une baisse des prix

Article d’opinion du Dr Nav Persaud dans le Toronto Star

Les annonces faites au sujet de l’assurance médicaments n’ont jamais amélioré la santé de la population. L’accord de confiance entre les libéraux et le NPD ne prévoit qu’un plan pour l’assurance médicaments d’ici 2025. Nous continuerons de recevoir des annonces concernant l’assurance médicaments, mais posons-nous la question : les médicaments seront-ils un jour pris en charge par notre système de santé publique?

Pour des raisons financières, on a promis des soins dentaires, mais pas l’assurance médicaments. En réduisant le prix de chaque comprimé, l’assurance médicaments permettrait d’économiser des milliards de dollars. L’actuel système fragmenté fait grimper le prix des médicaments. Les compagnies d’assurance privées, qui fournissent les régimes d’employeur dont profitent environ 60 % des Canadiens, prélèvent un pourcentage sur chaque demande de remboursement. Le Canada favorise donc les prix élevés des médicaments, alors que les médicaments sont moins chers dans des pays comme la Nouvelle-Zélande, l’Australie et le Royaume-Uni.

Une baisse des prix était censée se produire au Canada. Il y a cinq ans, le gouvernement Trudeau avait promis de s’attaquer aux prix élevés des médicaments brevetés en utilisant les pratiques de pays comme la Nouvelle-Zélande pour fixer des prix plafonds. La mise en œuvre de ce changement était censée être une étape vers l’instauration de l’assurance médicaments. Il y a cinq ans, la ministre de la Santé de l’époque, la Dre Jane Philpott, avait déclaré : « Les Canadiens vont constater que nous sommes en mesure de leur faire économiser des milliards de dollars par an. »

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Coronavirus: An Old New Friend

From TVO The Agenda with Steve Palkin

Watch the full interview here.

When the world was hit with a novel coronavirus two years ago, it was one of the handful of times this pathogen has been present. Or was it? Epidemiologist Dan Werb, author of “The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure,” discusses the world’s history with the coronavirus, the intersection of outbreaks, science, and the business of finding vaccines and treatments.

Toronto harm reduction advocates call for more frontline worker supports, drug regulation

From the CJRU 1280AM radio show

Toronto harm reduction workers magnify the need for additional supports in their roles and for a regulated, less toxic drug supply

Juno Zavitz, program coordinator of Breakaway Community Services’ grief, loss, and wellness initiative (GLoW) discusses additional support for harm reduction workers.

Haley Thompson, project manager of Toronto’s Drug Checking Service, highlights policy-related barriers to harm reduction present in the city. Last episode we heard that drug checking revealed high levels of contamination in the unregulated drug supply. Contamination refers to the addition of a drug to the original substance that drug using people do not expect to be present. The program informs those drug using people who submit samples what is in their drugs and alerts clinicians who treat drug using patients to potentially harmful substances in the drug supply.

Thompson calls on the need for regulation and decriminalization of the unregulated drug supply to combat the opioid poisoning crisis.

“There are a few safer supply programs popping up across the country but they tend to have rather stringent eligibility criteria. We’re supportive of the decriminalization of drugs for personal use because it separates drug use from criminality. But it’s definitely not sufficient because it does nothing to address the toxic drug crisis or the toxic drug supply, which is what we know is harming people,” says Thompson.

To End COVID-19, We Have to Admit That We’ve Failed

Op-ed in TIME Magazine by Dr. Dan Werb

In 1985, the first HIV vaccine trial was launched with great fanfare. The previous year, Margaret Heckler, the U.S. Secretary of Health and Human Services, confidently declared that an HIV vaccine would be created within two years. But almost four decades after the initial discovery of the HIV virus, there is still no viable HIV/AIDS vaccine. That doesn’t mean, though, that there is no cure. The grueling and largely thankless work of trialing an HIV/AIDS vaccine has continued steadily over the past four decades (the most recent one launched in January 2022, using Moderna’s mRNA technology), making it the longest-running modern pandemic.

But failure, in the hands of scientists, doesn’t mean the end. Instead, it is a sturdy foundation for scientific discovery. Rather than giving up, the failure to create a viable HIV vaccine spurred scientists to develop a whole new strategy to end the AIDS pandemic. Without vaccines available to teach human immune systems to kill the virus, scientists were forced to find other ways to keep infections at bay. And here’s where four decades of scientific failure was transformed into a radical approach to pandemic control, with direct implications for the future of the global effort to end COVID-19.

Coroner evaluating inquest request on cold-related homeless deaths in Toronto

From the CBC News article

Ontario’s chief coroner is investigating several cold-related deaths among Toronto’s homeless population and evaluating whether to hold an inquest on the issue.

An advocacy group has requested an inquest, Dr. Dirk Huyer said. At least two homeless people have died as a direct result of the cold in Toronto this winter, but advocates believe there are more.

“The inquest request is being evaluated by our regional supervising coroner,” Huyer said in an interview.

Health experts and advocates say there’s a lack of centralized data on homeless cold-related deaths and injuries, which they say makes it harder to push for changes to support those who live outside.

Those deaths and cold-related injuries don’t currently go into any central repository, said Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network.

There’s also currently no legislation that mandates systematic reporting of hypothermic injuries, unlike COVID-19 or tuberculosis cases, he said.

“I’m not sure if the problem of hypothermic injuries and deaths has got better or worse over the last year compared to previous years,” he said.

Hwang sought to get a better sense of hypothermic injuries and deaths in Toronto on his own several years ago. He had to comb through records of emergency departments and coroner records between 2005 and 2015.

He found 79 hypothermic injuries, such as severe frostbite, and 18 deaths in Toronto during that stretch.

MAP launches new podcast: MAPmaking

MAPmaking brings you Canada’s leading voices on the health equity issues that affect us all.

Together, we will discuss and explore the scientific evidence and real-world solutions that we believe have the potential to transform our country. Our vision is a Canada where everyone has the opportunity to thrive.

In this first season of MAPmaking, we are exploring the recommendations from MAP’s Equity Roadmap Report, a set of 13 recommendations for a more equitable COVID-19 pandemic recovery in Canada.

Episode one features Gautam Mukherjee, Executive Director of Houselink and Mainstay Community Housing. Gautam has worked in the housing and homelessness sector for 20 years and is a passionate advocate for social justice, inclusion and housing for all. In this episode, Gautam and MAP Director Stephen Hwang discuss and explore a recommendation from MAP’s Equity Roadmap Report: the expansion of permanent supportive housing programs with high fidelity to the Housing First approach.