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Where the parties stand: On homelessness

From the TVO Today article

HAMILTON — When it comes to preventing homelessness and supporting unhoused people in Ontario, “we’ve known what the solutions are for a very long time,” says Jesse Jenkinson, a postdoctoral fellow at MAP Centre for Urban Health Solutions. “It’s just whether or not anyone’s going to finally do something about it.” And the need for action, experts say, is great.

In March, Hamilton reported that 1,596 people had been actively homeless in the past three months. That number has climbed after COVID-19 — it sat at 1,105 as of April 1, 2020. The pandemic exacerbated homelessness by limiting shelter occupancy, reducing the availability of supports, and increasing the cost of living.

But even before then, homelessness had been on the rise in the province. A 2021 Statistics Canada study looking at data from 2010 to 2017 concluded that “homelessness in Ontario has been worsening over time, has been affecting younger cohorts, and has shifted geographically to smaller but rapidly growing municipalities.” A 2019 study in the medical journal BMJ Open estimated that, in 2016, about 60,000 Ontarians experienced homelessness. That was about 67 per cent higher than in 2007.

TVO.org speaks with experts about what the province needs to do to combat homelessness — and asks Ontario’s four major political parties to weigh in on their plans to address this worsening crisis.

Toronto’s homeless encampments are back on the fringes. Here’s why that’s a problem

From the Toronto Star article

In a narrow crevice between the soft earth of the Rosedale ravine and a concrete bridge just below Bloor Street, a 32-year-old man has lived in a makeshift camp, on and off, for months.

The man, who identified himself only as John, sometimes turns to Toronto’s shelter network to take a shower. He was once offered a shelter hotel spot, but kept feeling like there’d be a catch.

A handful of others live around John’s camp — six or seven lately, he estimates. He believes the ravine specifically draws in those who’ve struggled with living around other people.

As summer begins, they’re among the dozens of people weathering life under Toronto’s bridges, and in its parks, trails and ravines.

One year after encampments in high-profile locations such as Trinity Bellwoods Park and Lamport Stadium Park were thrust to the forefront of public debate, the number of camps citywide is down. Trinity Bellwoods is now empty of tents, but you can find makeshift structures and slung-up tarps in Toronto’s quieter, more concealed corners — with many remaining camps, like John’s, existing out of plain sight.

“I think it’s so important that people understand what’s happening,” said Dr. Stephen Hwang, a physician with St. Michael’s Hospital with a research focus on homelessness. That people still choose to live in ravines suggests Toronto is falling short of offering the help people need, he argued.

“The risk is not just that people will continue to be homeless on the street, or numbers will grow, but that we’ll become anesthetized to the problem — that we’ll stop seeing it as a human tragedy, and more as just a nuisance to be gotten rid of,” Hwang said.

Toronto city council to commemorate Canada’s first two Black doctors

From the CityNews article

Toronto City Council recently voted to celebrate Canada’s first two Black doctors with a pair of plaques close to where they lived, learned and practiced.

Doctors Alexander Augusta and Anderson Abbott lived in Toronto in the 19th century, each overcoming prejudice and racism to become leaders in Ontario’s Black community.

Dr. Nav Persaud, a staff physician at St. Michael’s Hospital, was part of the team that brought Augusta’s story forward to Heritage Toronto.

“The accounts that we have of him as a student indicate he was exemplary,” Persaud said.

“There were accounts of Augusta from some of his professors at the time, and others he had sought reference letters from,” he explained. “We can see the endorsements of Augusta at the time and it seems like there were a number of individuals in Toronto, or Upper Canada at the time, who thought very highly of Augusta and his abilities as a physician.”

Abbott, meanwhile, was born in Toronto in 1837. His parents came to the city three years earlier, from Alabama after their store was ransacked. Abbott went to University College and then to medical school. He apprenticed under Augusta and was licensed in 1862, making him the first Canadian-born Black doctor.

Help us fix family doctor shortage ‘crisis,’ GPs tell Ontario election candidates

From the Toronto Star article

The Ontario College of Family Physicians (OCFP) recently launched its campaign, “Life Without A Doctor,” to put what it says is the province’s lack of equitable access to a family doctor front and centre in the provincial election.

Currently, 1.3 million Ontarians live without a family doctor, OCFP reported.

Dr. Tara Kiran, a principal investigator in both research studies and a family doctor in a family health team at St. Michael’s Hospital, called the findings “an important wake-up call” to address Ontario’s family physician shortage.

“Now we know the pandemic has driven some people out of the workforce, and others are burned out and thinking, for various reasons, to potentially stop working,” said Kiran, who is Fidani Chair in improvement and innovation and vice-chair, quality and innovation at the Department of Family and Community Medicine at the University of Toronto.

“So, we have a crisis in being able to sustain the health-care resources needed to be able to provide primary care to serve our population.”

Ontario political parties promise help on opioid crisis as election looms

From the Toronto Star article

PARIS – Paolo Dinola doesn’t really care who wins the provincial election so long as the next government tries to save others from the fate of his son, who became another statistic last year in Ontario’s surging opioid crisis.

Aaron Dinola died on Nov. 6, 2021, after a fentanyl overdose. He was 32 years old and a father of three.

“He was my beautiful boy, he always had a good heart, but got addicted to painkillers after a car accident,” Paolo Dinola said in an interview. “Three years later he’s dead from fentanyl – the system failed him.”

Opioid deaths and hospitalizations surged significantly across the province after the pandemic hit in early 2020.

The Office of the Chief Coroner shared data on Thursday that showed 2,819 people died from opioid toxicity in 2021. That’s up from 2,460 opioid deaths the year before – a figure that itself was up 58 per cent from fatalities recorded in 2019.

Both the NDP and the Liberals pledged to help tackle the opioid problem on Thursday while Progressive Conservative Leader Doug Ford said a few days earlier that he’d help anyone with an addiction problem.

Dinola was at a cafe in Paris, Ont., where NDP Leader Andrea Horwath made a campaign stop and pledged to reform the mental health system.

Tara Gomes, an epidemiologist at Unity Health, said there’s no urgency from either the province or the federal government.

Gomes said both levels of government need to relax rules on proven opioid treatments like suboxone and methadone, vast expansion of harm reduction, safe spaces to use drugs and decriminalize drugs.

“Even as we’ve seen these waves come and go with the pandemic, opioid-related deaths are just climbing year over year,” Gomes said.

“And this isn’t something that seems to be resolving any time soon.”

Open Letter: Ontario social assistance recipients need a basic living standard

May 16, 2022

We are community advocates and peer researchers with lived experience of low income Ontario Works (OW) and Ontario Disability Support Program (ODSP) who live and work in Toronto. We work with scientists and staff at MAP Centre for Urban Health Solutions at St. Michael’s Hospital to align our community priorities with health equity research in partnership with other agencies across Toronto. As MAP Community Expert Group members, we are calling upon all registered political parties, leaders, and MPP candidates in Ontario to take action on the challenges that OW and ODSP recipients experience. We face low financial assistance rates and income claw-backs that hit hard, especially for single adults with lived experience of mental health issues and poverty.

We are united in our disappointment with the current amounts we are forced to live on and the punitive claw-backs of other forms of income that are part of the design of Ontario social assistance programs. Health care staff, clinicians, scientists at MAP and advocates across Toronto are co-signatories of this letter to indicate their agreement and solidarity.  

“A modernized social assistance system must recognize that not all citizens are able to remain attached to the labor market and when they are unable to participate in labor market activities, the support programs that they are forced to rely on must reflect the actual costs that the market commands to ensure that recipients are able to afford the rent, other necessities of life and to put food on the table to improve their social determinants of health.” – ODSP recipient

Ontario social assistance rates are insufficient to cover basic needs 

There are 863,000 people in Ontario who rely on social assistance programs, and we acknowledge Ontario’s government’s responsibility to provide financial assistance to meet basic living expenses, health and employment services to these Ontarians. However, single adults only receive up to $733 per month under OW and up to $1,169 per month on ODSP for basic needs and shelter. These amounts are simply not enough. The vast majority of provinces and territories do not index social assistance rates to the cost of living. This contributes to many people’s inability to meet their basic needs or to exit the program with sufficient resources. In Ontario, rates have not increased since 2018 and have not kept up with inflation of 10% –  In addition, single individuals on OW and ODSP experience a 63 percent and 40 percent poverty gap respectively when their rates are compared with official poverty standards.

The amount of money provided to cover basic needs such as food and shelter is not reflective of the increasing cost of living in Ontario, particularly in Toronto. OW allocates $390 per month to a single adult for shelter, thus making it impossible to secure housing. Current market rents for a shared room in Toronto now exceed $500 per month everywhere in the City, effectively excluding recipients from securing adequate accommodation. Moreover, it leaves them either in precariously housed situations or at-risk of homelessness.

In addition, well over half (59%) of people on social assistance in Ontario experience food insecurity and are more likely to rely on food banks, as the amounts they receive are not sufficient to cover food or transportation.

We find shameful the provincial Government’s failure to recognize that Ontario’s social assistance programs do not meet the needs of its recipients. This situation points to a lack of inclusion of community voices in policy decision making. We strongly recommend that the new provincial government align recipients’ incomes with a basic living standard along with annual inflationary increases.

“The OW shelter money is not high enough to rent a room. I have to use 2/3 of my basic money to cover the rent which leave me nothing much for food, transportation and other expenses. Even so, the room is shabby resulting in bad living conditions. The shelter allowance forces people into homelessness and puts them at a greater risk for poor health.” – OW recipient

We applaud the efforts of various community organizations and advocates who have petitioned to index the programs’ rates with the current inflation rate. Others have called on the provincial government increase the rates to $2,000 per month. This amount aligns with the Federal Government’s COVID-19 Emergency Response Benefit (CERB) program which was deemed a basic income for individuals affected by the COVID-19 pandemic.

Complicated and punitive benefit claw-backs do not help recipients to stabilize their life

The punitive benefit claw-backs on income in OW and ODSP, combined with limited availability of supportive services and systemic barriers, prevent many people from securing stable employment. Precarious employment such as part-time jobs or short-term contracts have become more common in Ontario’s labour market, and low-income earners are overrepresented in these jobs. Social assistance recipients who take these jobs to supplement their income are constantly worried about having to pay back their benefits if their income exceeds a certain amount. Moreover, individuals with a disability have a harder time finding employment that offers adequate accommodations, a living wage, and stable benefits.

“ODSP does not encourage us to improve our lives, they restrict us from moving forward. Forcing us to be stagnant. Additionally, Government strategies to modernization Ontario Social Assistance programs have never provided us with any significant advantages but further complicate the process.” – ODSP recipient

“The claw-back of 50 percent for each additional dollar earned above $200 is too punitive to incentivize ODSP recipients to move into the labour market, as it fails to move them out of deep poverty. This threshold should be increased to $800 to reflect increasing costs of living.” – ODSP recipient

Income claw-backs and exemption rate policies are often unclear to recipients and create a dynamic that discourages people from seeking employment. Additionally, in some instances it leaves recipients worse off than if they did not pursue any type of employment.

It is imperative that punitive income claw-backs are lessened and the exemptions on earned income are increased. Facilitating more pathways for recipients to earn more income will not only help people work towards their financial goals, but will ultimately reduce their dependence on social assistance programs.

“Anyone earning more than $300.00 per month ends up losing earned income and their Work Incentive benefit.  For instance, if person earned $300 plus the work incentive they should have collected $400.00 but with ODSP’s calculation they only get $350. As people earn more, they lose more of their earned money. Additionally, Rent/Food/Incidentals have not been adequately covered to survive in the City” – ODSP recipient  

These factors create barriers for people and negatively impact their quality of life. Social assistance recipients have limited access to preventative healthcare services not covered through the provincial or municipal government programs. While a few basic services such as dental care are covered for ODSP recipients, OW recipients have very little coverage, and therefore very little access to basic services. It has been shown that recipients of social assistance programs have worse health outcomes than non-recipients. Lack of priority for  Ontarians living in poverty is costly for our healthcare system, and will continue to escalate in costs as people experience more poverty-related negative health outcomes. As we approach Ontario’s provincial election in June, we strongly urge political parties to develop, publicize, and commit to more responsive and equity-based social assistance programs that are tailored to the real needs of recipients.

Thank you for your attention to these vital issues that greatly affect the health and wellbeing of low- income people in Ontario. We hope our political leaders support our recommendations and commit to providing financial support for all Ontarians to have good health and thrive in our communities.

Sincerely,

MAP Community Expert Group members

Bee Lee Soh 

Rene Adams 

Daniela Mergarten 

Sa’ad Talia 

Veronica Snooks 

Opal Sparks 

Supported by:

Stephen Hwang Physician in General Internal Medicine and Research Scientist, MAP Centre for Urban Health Solutions

Shazeen Suleman Investigator, MAP Centre for Urban Health Solutions

Galo F. Ginocchio Research Coordinator, Unity Health Toronto – St. Michael’s Hospital

Sloane Freeman Pediatrician, St. Michael’s Hospital, Unity Health Toronto

Vikram Jayanth Ramalingam Research Assistant, MAP Centre for Urban Health Solutions, St. Michaels Hospital

Anne-Marie Tynan Research Program Manager, MAP Centre for Urban Health Solutions

Sean B. Rourke, PhD, FCAHS Scientist, MAP Centre for Urban Health Solutions, St. Michael’s Hospital

Flora Matheson Scientist, Unity Health Toronto

John Ecker Research Manager, MAP Centre for Urban Health Solutions, Unity Health Toronto

Uzma Ahmed Research Coordinator, MAP Centre for Urban Health Solutions

Areesha Sabir Research Coordinator, St. Michael’s Hospital, Unity Health Toronto

Alyssa Ranieri Homeless Outreach Counselor, Unity Health Toronto

Sharmistha Mishra Associate Professor & Infectious Disease Specialist, University of Toronto & Unity Health Toronto

Sherry Hao Research Assistant ll, MAP Centre for Urban Health Solutions

Suzanne Zerger Research Program Manager, MAP Centre for Urban Health Solutions, Unity Health

Madison Ford Research Coordinator, MAP Centre for Urban Health Solutions

Ray Baran Research Coordinator, REACH Nexus

Stephanie Arlt Research Coordinator, MAP Centre for Urban Health Solutions

Antigone Darsini CRC II, St. Michael’s Hospital

Dr. Naomi Thulien Scientist, MAP Centre for Urban Health Solutions, St. Michael’s Hospital Unity Health Toronto

Sam Filipenko Business Manager, Well Living House

Kate Francombe Pridham Research Program Manager – Homelessness, Housing, and Health, MAP Centre for Urban Health Solutions

Jillian Macklin MD/PhD Student, University of Toronto

James R Dunn Professor / Scientist, McMaster University / St. Michael’s Hospital

Dana Shearer Knowledge Translation Broker, Ontario Drug Policy Research Network

Darrell Tan Clinician-Scientist, St Michael’s Hospital

charles ozzoude Health Researcher , St. Michael’s Hospital

layla jabbour Research Program Manager, Centre on Drug Policy Evaluation

Michelle Catchpole Business Analyst, MAP Centre for Urban Health Solutions

Amy Craig-Neil Research Coordinator, MAP Centre for Urban Health Solutions, Unity Health Toronto

Heather McLean Research Assistant II, MAP Centre for Urban Health Solutions Centre on Drug Policy Evaluation

Ahmed Bayoumi Clinician Scientist, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto

Jesse Isadora Reisman Jenkinson Postdoctoral Fellow, MAP Centre for Urban Health Solutions, Unity Health Toronto

Nazlee Maghsoudi Manager, Policy Impact Unit, Centre on Drug Policy Evaluation

Kimberly Devotta Research Manager, Unity Health Toronto

Indhu Rammohan Graduate student, Centre for Drug Policy Evaluation

Jeanette Bowles  Postdoctoral Fellow, Centre on Drug Policy Evaluation: St. Michael’s Hosptial

Lisa Schlosser Peer Support Specialist, SMH

Janet Brown  Director Strategic Projects, MAP Centre for Urban Health Solutions

Tara Kiran Family Physician and Associate Professor,  University of Toronto

Anne Rucchetto Research staff, Unity Health Toronto

Evie Gogosis Research Manager, MAP Centre for Urban Health Solutions

Paige Homme  Medical Student, Year 3, University of Toronto

Pearl Buhariwala Research Manager, MAP Centre for Urban Health Solutions

Melissa Perri Research Assistant, MAP Centre for Urban Health Solutions

Parvin Merchant Director – Tenant and Member Service, Houselink and Mainstay Community Housing

Vanesa Berenstein Research Coordinator, MAP Centre for Urban Health Solutions

Rachel Ma Research Volunteer, MAP Centre for Urban Health Solutions

Paneet Gill Practicum Student, MAP Centre for Urban Health Solutions St Micheal’s Hospital

Dan Werb Director, Centre on Drug Policy Evaluation

Elham Rasoulian Research Coordinator I, MAP Centre for Urban Health Solutions

Lisa Baker Mental Health Outreach Worker, Unity Health

Joy Connelly Housing consultant and advocate, Connelly Consulting Services

Christina Muratore Care and Transitions Facilitator, St. Michael’s Hospital

Shelagh Pizey-Allen Executive Director, TTCriders

Rosalie Donaldson-Kronenbuerger social worker, Unity Health Toronto

Michael Creek Director Strategic Initiatives, Working for Change

Ali Minaei ODSP Recipient, N/A

Samar Abdulle Research Coordinator, Unity Health Toronto

Aiko Ito Client Intervention Worker MSW RSW, Dixon Hall Neighbourhood Services

Victor Willis Executive Director, PARC (The Parkdale Activity – Recreation Centre Toronto)

Trevor Manson Secretary Co-chair, ODSP Action Coalition

Ryan Peck Executive Director, HIV & AIDS Legal Clinic Ontario (HALCO)

Steve Durant Research Coordinator, The Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto

Zahra Tahlil Outreach-Emergency Department, St.Michael’s Hospital

Elizabeth Mulholland CEO, Prosper Canada

Devorah Kobluk Senior Policy Analyst, Income Security Advocacy Centre (ISAC)

Fiona Penny Social Worker, St Michael’s Hospital

Indira Fernando research manager, St. Michael’s hospital

Chi-Hang Jonathan Sinn MPH Practicum Student, MAP Centre for Urban Health Solutions (St. Michael’s Hospital)

Emily Holton Communications & Marketing Manager, MAP Centre for Urban Health Solutions

Feroza Mohammed Community Worker; Member, Local Champions’ Network, Autonomous Residents’ Leadership Network

Zoe Greenwald PhD Candidate in Epidemiology, University of Toronto

Alexandra Carasco Research Coordinator, MAP Centre for Urban Health Solutions

Samantha Myers Research Assistant II, St. Michael’s Hospital

Amy Katz, Knowledge Translation Specialist, MAP, St. Michael’s Hospital, Unity Health Toronto

John Stapleton, Principal, Open Policy

Heather McGregor, CEO, YWCA Toronto

Melissa Goldstein, No affiliation

Charles Ritchie, No affiliation

Melody Li, Executive Director, Homeless Connect Toronto

Gary Bloch Family Physician, Unity Health Toronto

Adam cohoon Founder, Moreaccessible

Terry Pariseau, Coordinated Access Engagement Coordinator, Toronto Alliance to End Homelessness

Diana Chan McNally, Training and Engagement Coordinator,Toronto Drop-in Network

Miranda Schreiber, U of T

Allison Meserve, Senior Manager , Prosper Canada

Benjamin Wong, Epidemiologist

Rev. Steve Hoffard, Pastor, Redeemer Lutheran – Toronto

Steve Joseph, Torresan Treasurer, Dream Team

Shalini Konanur, Executive Director / Lawyer, South Asian Legal Clinic of Ontario

Edward Russell, Volunteer Gardener/Yardman, Houselink/Mainstay

Ayan Yusuf, Research Coordinator, MAP Centre for Urban Health Solutions

David Meyers, Senior Manager, Centre for Independent Living in Toronto

Shurrytwo Pan, Social Assistance, No affiliation

Nathalie Noël

Oksana Grebnytska, Co-Founder, Social Assistance Coalition of Scarborough (SACS)

Alies Maybee, Citizen n/a

Geena Ross, Advocate, No Affiliation

Teresa Northcote, ODSP Recipient

Anne Gloger, Principal, Openly Connected

Helen P Watt, Senior Program Officer, Prosper Canada

David Meyers, Coalition Partner representative, GTA Disability Coalition

akiesha phillips, SACS

Elizabeth Tremblay, Founder Mentor/Mentee Canada and Peer House Toronto

Amie Tsang, Health Equity Facilitator, CMHA Toronto

Heath Soave, Anti-Poverty, Paralegal

Angie Peters, President & CEO, Yonge Street Mission

Carrie Wong, Manager, Learning and Training Prosper Canada

Michael Anhorn, CEO Canadian Mental Health Association Toronto Branch

Sivabalan Arulnanthysivam, injured worker, Voice of Scarborough member.

Melissa Blacktopp, no affiliation

Savhanna J Wilson, Associate Director, Toronto Alliance to End Homelessness

Marlene Rathbone, No affiliation

Kathlyn Babaran-Henfrey, Research Coordinator, Unity Health Toronto

Homeless adolescents in the United States experience significantly worse mental health and substance use outcomes than housed counterparts: study

From Unity Health Toronto

Adolescents experiencing homelessness in the United States have significantly worse mental health and substance use outcomes than their housed counterparts, according to new research that evaluated mental health and substance use among homeless and housed high school students surveyed voluntarily and anonymously in 2019.

The research, published in JAMA and co-led by researchers from MAP Centre for Urban Health Solutions at St. Michael’s Hospital, also found that teens of colour and teens who identify as LGBTQIA+ bear the disproportionate burden of homelessness in the United States.

More than one in 20 U.S. high school students experienced homelessness in 2016 and 2017, according to a 2018 report from the United States Department of Housing and Urban Development. While the circumstances surrounding these adolescents’ homelessness are undoubtedly stressful and traumatic, few reliable and large-scale assessments of the psychiatric burden among homeless teens are available.

“Our study is a call-to-action for schools, health systems, and policymakers to address the significant burden of mental health and substance use challenges faced by homeless adolescents,” said Michael Liu, MPhil, first author of the study, a research coordinator at St. Michael’s MAP Centre for Urban Health Solutions and a medical student at Harvard Medical School. “The burden of homelessness falls disproportionately on Black, Hispanic, and LGBTQIA+ individuals, which reflects enduring structural injustices such as racism, homophobia, and transphobia in the US. We need to do a better job of identifying these students and connecting them to evidence-based interventions such as stable housing and mental health support.”

Where the parties stand: On the opioid crisis

From the TVO Today article

Opioids have killed almost 10,000 people in Ontario over the past five years, according to data from Ontario’s Office of the Chief Coroner. Nearly 3,000 people died of confirmed or probable opioid-related causes in 2021 alone — a figure that equates to roughly eight people per day — the highest rate of fatal opioid overdoses ever recorded in the province. 

Opioid-related deaths have been on the rise in Ontario for more than a decade, but there has been a “significant rise” in unintentional opioid-related deaths during the pandemic, according to a January report from Public Health Ontario. The report says this is due in part to increased social isolation and reduced access to health-care services and community-based programs for people who use drugs.

Experts say more can be done to reduce fatalities and manage the province’s ongoing opioid crisis.

The issue

“We can’t forget that behind these numbers are the lives of people that have been lost, often very early in life, from an avoidable cause,” says Tara Gomes, a researcher with Unity Health Toronto. 

The PHO report compares two separate time periods: the pre-pandemic period from March 17, 2019, through to December 31, 2019, in which 1,017 people in Ontario died from opioid-related causes; and the pandemic period, from March 17, 2020, to December 31, 2020, in which that number jumped to 1,808. 

From universal pharmacare to affordable housing, experts break down provincial NDP’s election platform

From CBC Metro Morning

Listen to the interview here.

Nemoy Lewis is an assistant professor in the School of Urban and Regional Planning at Ryerson University. Dr. Nav Persaud is an associate professor of Department of Family and Community Medicine. He’s also a family doctor and Canada Research Chait in Health Justice at St. Michael’s Hospital. Both joined Metro Morning to share their thoughts on the provincial NDP’s election platform.