Author: Emily Holton

MAP Centre for Urban Health Solutions has launched 10 collaborative solutions networks with a common goal: to effect real-world social change by co-designing and demonstrating what works to address critical urban health challenges in our communities.

The 10 networks, made up of more than 170 scientists, community partners, policy makers, and people with lived expertise from across the country, came together March 2-3, 2020, for a symposium in Toronto.

About the Symposium

The Solutions for Healthy Cities Symposium was an important opportunity for network members to meet in person, share experiences, learn from each other, and mobilize to chart their paths forward. The agenda included a mix of working sessions in network teams, and time for discussion and learning as a full group.

The Symposium opened and concluded with remarks from Cat Criger, an Indigenous Elder, Traditional Teacher and Knowledge Keeper. Symposium speakers included:

• Namaste Marsden & Leona Star: Advancing standards and processes for First Nations, Inuit and Métis engagement in research about them
• Alisa Velonis: Tools for guided implementation
• Sam Tsemberis: Reflections on innovation, advocacy and policy change

“It’s nice, and rare, to have an occasion for critical thinking. Symposiums and conferences are usually about self-promotion, but not this one!” – Network member

“Having the face to face time to get to know one another was so valuable. Not usually included in research funding but should be!” – Network member

The Keynote Reception

At the much-anticipated keynote event, Mayor Lori E. Lightfoot, City of Chicago, addressed network members and guests. MAP Director Dr. Stephen Hwang also spoke.

Mayor Lightfoot was then joined by Mayor John Tory, City of Toronto, for a fireside chat. The discussion was moderated by Dr. Pat O’Campo, senior MAP scientist and Executive Director of the Li Ka Shing Knowledge Institute.

Among the guests in attendance were two former premiers of Ontario, David Peterson and Kathleen Wynne, former deputy premier Deb Matthews, and former Mississauga mayor Hazel McCallion.

Participants and guests, including Mayor John Tory, shared their thoughts and highlights on Twitter using the #Solutions4HealthyCities hashtag.

Read more about the event in this Unity Health Toronto article.

Co-designing for Real-world Impact: The National Solutions Networks

With the vision of creating “a healthier future for all,” the 10 solutions networks are taking on complex issues including chronic homelessness, intimate partner violence, the long-term effects of socioeconomic adversity in early life, and the links between traumatic brain injury and incarceration.

The networks’ cross-sectoral membership and partnered approach are the keys to ensuring that solutions are feasible, appropriate, and effective — and that they reflect the goals, priorities, and contexts of the communities they aim to serve.

The result will be 10 evidence-based solutions that are tested and ready for scale-up in cities across Canada.

Together, we can create a healthier future for all.

The Solutions for Healthy Cities Symposium was made possible in partnership with the St. Michael’s Hospital Foundation and thanks to the generous contributions of its visionary donors. We also wish to thank Jackman Reinvents for their incredible work bringing our message and work to life, and Spark Inc. for their superb event management.

For his work to improve the health of people experiencing homelessness and to make social justice and health equity central to medical practice, Dr. Stephen Hwang has received the University of Toronto President’s Impact Award.

A professor in the department of medicine and scientist in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Hwang is a world-renowned expert. His research and advocacy has elucidated the causes and risk factors for death among homeless people, the relationship between traumatic brain injury and homelessness, and the effects of homelessness on health status.

Hwang has played a pivotal role in advancing Canadian and international scholarship and advocacy related to homelessness. His work helped inspire the creation of the 100,000 Homes Campaign, which has mobilized officials in hundreds of cities across the U.S. to house thousands of long-term and medically vulnerable homeless individuals who were at increased risk of death.

“Homelessness affects hundreds of thousands of Canadians and takes a tremendous toll on health,” Hwang said. “Our work has shown that the Housing First approach ends chronic homelessness and should be widely implemented. This award will support our ongoing research on new interventions to meet complex health needs and improve well-being and social integration among people experiencing homelessness.”

…Stephen Hwang, MD, an internist, homelessness researcher, and director of [MAP Centre for Urban Health Solutions] at St. Michael’s Hospital in Toronto, said “living on the streets or in a shelter is a hazardous environment.”

He said neurologists treating homeless patients should be aware of the possibility that a history of TBI could be the cause of behavioral issues, seizures or unexplained cognitive deficits. He helped craft recommendations issued in October 2018 by the National Health Care for the Homeless Council that focus on the care of patients who are homeless and living with the effects of TBI. It includes recommendations for assessment of possible deficits, including which screening tools to use.

Over one billion people globally experience some form of disability, yet despite having greater health needs, people with disabilities often encounter barriers to accessing care and have worse outcomes.

In a study published in Disability and Health Journal, MAP scientists Dr. Andrew Pinto and Dr. Tara Kiran examined how patients responded to being asked about disabilities as part of a routine survey and compared survey responses to data available in medical charts.

Featuring MAP scientist Dr. Ann Burchell, and her project: Effectiveness of human papillomavirus vaccine in gay, bisexual and other men who have sex with men

Five cases of the mysterious Wuhan coronavirus have been confirmed in the United States, giving rise to concerns about a potential global pandemic. We’ve seen this story before, as health authorities working with threadbare data try to walk the line between epidemic readiness and needless panic. Is this new outbreak poised to become the next AIDS pandemic or a new SARS, which was stopped in its tracks after 774 deaths? To cut through the headlines, we can use a simple concept called the “epidemic triangle.” Employed by epidemiologists since the discipline’s earliest days, it is indispensable in predicting whether localized outbreaks will transform into full-blown epidemics.

…One stumbling block for approval from Health Canada has been the lack of a clinical trial in Canada showing how accurate and easy to use the kits are, and whether users will seek medical care if they test positive. So, Dr. Sean Rourke, a psychiatrist and scientist at MAP Centre for Urban Health Solutions, raised the money for a 1,000-person clinical trial across give Canadian cities on INSTI finger-prick self-testing kits. Pant Pai is running the Quebec side of the trial. They expect it to be finished in February.

Once bio-Lytical submits the results to Health Canada, Rourke predicts the government will have everything it needs to approve the kits. “Hopefully by early spring or summer, the first self-test kits will be available in Canada,” he says.

…If self-test kits are finally approved for drug-store shelves and if more Canadians living with HIV gain access to medication, it’s a whole new world.

“We can end the HIV epidemic,” says Rourke. “Other countries have targets for 2030. We can do this in three to five years.”

The three biggest problems for patients surveyed about their discharge from Ontario hospitals all concern publicly funded home care, according to new research published in an international medical journal.

The researchers hope the findings will encourage improvements in the hospital-to-home transition navigated by some one million patients every year in this province.

Children who drink whole milk are less likely to be obese, according to a study which questions international dietary guidelines.

Researchers analysed data from 28 existing studies across seven countries involving a total of 20,897 healthy children aged between one and 18 years old. They concluded those who drank whole milk had a 40 percent lower chance of being overweight or obese compared with those who drank low-fat milk. The findings were published in The American Journal of Clinical Nutrition.

Published Dec. 20, 2019

Summary

In Toronto, the Medical Officer of Health issues an extreme cold weather alert when temperatures fall below -15C. Recently, researchers led by St. Michael’s Hospital reviewed coroner’s records and emergency department charts from five downtown hospitals to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness between 2004-2015. They found that while extreme cold temperatures put people at higher risk of hypothermia, most cases of injury and death due to cold occur in moderate winter weather.

This data suggests that the current state of the housing, shelter, respite, and warming centre systems in Toronto leaves many people at risk of injury and death due to cold. For example, there is currently only one warming centre open during extreme cold weather alerts (Metro Hall, with a capacity for 50 people). It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

Background

In Toronto, extreme cold weather alerts trigger additional services for people experiencing homelessness. One dedicated warming centre opens at Metro Hall, and there are additional overnight street outreach staff. Community agencies are also asked to relax service restrictions and let more people inside.

According to the City’s Shelter Census, most emergency shelters, respite centres and volunteer Out of the Cold programs are at or exceeding capacity. Even when the Metro Hall warming centre is open during extreme cold weather alerts, many people are still left outside. For example, in a recent interview, an outreach worker described how his client was turned away from Metro Hall, leaving her with no option but to sleep on the street. This suggests that more warming centres are needed, and not just during extreme cold weather alerts, but all winter long.

About the Research

Researchers reviewed coroner’s records, and charts from emergency departments at St. Michael’s Hospital, Mount Sinai Hospital, Toronto General Hospital, Toronto Western Hospital, and St. Joseph’s Health Centre to explore the relationship between weather conditions and hypothermia among adults experiencing homelessness in Toronto between 2004 – 2015.

Findings

• Seventy-two percent of hypothermia cases in people experiencing homelessness occur when temperatures are warmer than -15C, the threshold for an extreme cold weather alert.
• Rain, snow and damp amplify the effects of cold temperatures, leading to more cases of hypothermia.
• People who are homeless in Toronto are much more likely to experience hypothermia than the general population. People who are homeless account for 25% of all hypothermic injuries and 20% of hypothermic deaths.
• While moderate winter weather puts people experiencing homelessness at increased risk of injury and death, extreme cold weather further heightens this risk.

Implications

The current state of the housing, shelter, respite and warming centre systems in Toronto leaves many people at risk of injury and death.

It is critically important to have a cold weather response strategy that includes low-barrier access to shelter beds and multiple warming centres throughout the winter months, not just on extremely cold days and nights.

For more information about this evidence brief, please contact MAP Director Dr. Stephen Hwang: Stephen.Hwang@unityhealth.to

References

• Zhang P, Wiens K, Wang R, Luong L, Ansara D, Gower S, Bassil K & Hwang SW. (2019). Cold Weather Conditions and Risk of Hypothermia Among People Experiencing Homelessness: Implications for Prevention Strategies. International Journal of Environmental Research and Public Health.
• CP24 clip