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Program led by St. Michael’s Hospital to dispense free HIV self-testing kits, harm reduction, sexual health supplies

TORONTO – Machines that dispense free self-testing kits for HIV and COVID-19, naloxone kits, new needles, condoms and other essential harm reduction and sexual health supplies will soon appear in communities across Canada.

The ‘smart’ machines, called Our Healthbox, work like a vending machine, and also provide health information and a service directory for people to find much-needed health care and supports in their community. The initiative, led by researchers at St. Michael’s Hospital, a site of Unity Health Toronto, will launch in four communities in New Brunswick on Jan. 23, with plans to launch up to 50 machines across Canada in 2023. The goal is to install 100 machines over the next three years, and to evaluate how well they support people with their health needs.

The initiative launches as new HIV cases in Canada rise and the country’s opioid crisis claims the lives of 20 Canadians each day. Providing access to harm reduction and health care supplies for free to people in spaces they frequent is a strategy experts consider as key to reaching people who are underserved and who have barriers to accessing testing, harm reduction materials, treatment, care and prevention due to racism, homophobia, stigma and discrimination.

“Everyone in Canada deserves to have what they need, when they need it, to take care of their health. But we know that this is not the case, and so we are doing everything we can to bridge that gap in ways that work for each person in their community,” said Dr. Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions, a world-leading research centre housed at St. Michael’s Hospital, and the Director of REACH Nexus, a national research group working on how to address access and treatment for HIV, Hepatitis C and other sexually transmitted and blood-borne infections.

Our Healthbox is the latest phase of work led by Rourke to connect those with complex health and social circumstances to testing, treatment and prevention. In 2019, Rourke spearheaded a cross-Canada clinical trial which evaluated and proved the accuracy of HIV-self tests – Health Canada approved the tests for use in November 2020 based on the results of the trial. In June 2022, Rourke launched the I’m Ready research program, distributing 10,000 free HIV self-testing kits across Canada to reach people who are undiagnosed and get them connected to care, with the goal of identifying the factors that affect access to testing and care.

Rourke and his team will work with local community-based organizations, public health authorities, and health centres to host and maintain Our Healthbox program. Each agency determines the supplies needed in the machines to serve the people in their community. The east coast launch of Our Healthbox is funded by Even the Odds, a partnership between Staples Canada and MAP Centre for Urban Health Solutions.

“Our Healthbox will ensure underserved individuals in the community have low barrier access to resources that not only reduce their risk of infections, but in fact save their lives,” said Deborah R. Warren, Executive Director at ENSEMBLE, a community-based organization in Moncton, N.B. that works to address complex social issues by providing support, education and prevention initiatives. “We are currently in the midst of a substance use crisis that sees the death of one New Brunswicker every four days. Providing access to free naloxone will save many lives.”

Our Healthbox is funded by the Canadian Institutes of Health Research (CIHR), the Public Health Agency of Canada, the Canadian Foundation for AIDS Research (CANFAR), the St. Michael’s Hospital Foundation, and Even The Odds (Staples Canada and MAP).

About MAP Centre for Urban Health Solutions

MAP is a world-leading research centre dedicated to creating a healthier future for all. Through big-picture research and street-level solutions, MAP scientists tackle complex community health issues—many at the intersection of health and equity. MAP works in partnership with communities, researchers, and government leaders across Canada to address issues such as homelessness, unequal access to health care and medicine, and the lifelong effects of childhood poverty. MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto. For more information, visit maphealth.ca.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit unityhealth.to.

About Even the Odds

Staples Canada and MAP have come together to create Even the Odds: an initiative to raise awareness of inequity in Canada and to help build vibrant, healthy communities. The partnership is based on the shared belief that everyone should have the opportunity to thrive. Even the Odds will support MAP’s research and programs across Canada. It is a bold commitment to make a difference in Canada’s unique and diverse communities through corporate donations, fundraising and awareness. For more information, visit staples.ca/eventheodds

Media Contact

Hayley Mick or Jennifer Stranges: communications@unityhealth.to

Des distributeurs automatiques de fournitures de réduction des méfaits et des risques seront installés partout au Canada

Un programme dirigé par l’Hôpital St Michael destiné à distribuer gratuitement des trousses d’autodépistage du VIH, ainsi que des fournitures de réduction des méfaits et des risques et de santé sexuelle.

TORONTO – Des machines distribuant gratuitement des trousses d’autodépistage du VIH et de la COVID-19, des trousses de naloxone, des nouvelles aiguilles, des condoms et d’autres articles essentiels à la réduction des méfaits et des risques et à la santé sexuelle feront bientôt leur apparition dans les communautés à travers tout le Canada.

Ces machines « intelligentes », appelées Notre Boîtesanté, fonctionnent comme des distributeurs automatiques. Elles fournissent également des informations en matière de santé et un répertoire de services qui permet aux individus d’obtenir, dans leur communauté, d’indispensables soins de santé et services de soutien. L’initiative, dirigée par des chercheurs de l’Hôpital St Michael, un établissement d’Unity Health Toronto, sera inaugurée le 23 janvier au sein de quatre communautés du Nouveau-Brunswick, et il est prévu d’installer jusqu’à 50 machines à travers le Canada en 2023. L’objectif est d’installer 100 distributeurs au cours des trois prochaines années et d’évaluer dans quelle mesure ils apportent une réponse adaptée aux besoins des individus en matière de santé.

Cette initiative est lancée alors que le nombre de nouveaux cas de VIH au Canada est en augmentation et que la crise des opioïdes coûte la vie à 20 Canadiens chaque jour. Fournir aux personnes un accès gratuit à des fournitures de réduction des méfaits et des risques et à des soins de santé au cœur des espaces qu’elles fréquentent est une stratégie que les experts considèrent comme essentielle pour rejoindre les personnes habituellement mal desservies ou qui se heurtent à des obstacles pour accéder au dépistage, au matériel de réduction des méfaits et des risques, aux traitements, aux soins et à la prévention. Ces barrières à l’accès peuvent survenir en raison du racisme, de l’homophobie, de la stigmatisation ou de la discrimination.

« Pour prendre soin de sa santé, tout le monde au Canada mérite d’avoir accès à ce dont il a besoin, quand il en a besoin. Mais nous savons que ce n’est pas le cas, alors nous faisons tout ce que nous pouvons pour combler ce fossé avec des moyens qui fonctionnent pour chaque individu au sein de sa communauté », a déclaré le Docteur Sean B. Rourke, chercheur au sein du MAP Centre for Urban Health Solutions, un centre de recherche de calibre mondial situé à l’Hôpital St Michael, et directeur de REACH Nexus : un groupe de recherche national travaillant sur la façon de gérer au mieux l’accès aux soins et aux traitements pour le VIH, l’hépatite C et d’autres infections transmissibles sexuellement et par le sang.

Notre Boîtesanté est le plus récent développement du travail mené par le Docteur Rourke afin de connecter les personnes confrontées à des circonstances sanitaires et sociales complexes au dépistage, aux traitements et à la prévention. En 2019, le Docteur Rourke a dirigé un essai clinique pancanadien qui a évalué et prouvé la fiabilité des tests d’autodépistage du VIH – Santé Canada a approuvé l’utilisation de ces tests en novembre 2020 sur la base des résultats de l’essai. En juin 2022, le Docteur Rourke a lancé le programme de recherche I’m Ready/J’AGIS, visant à distribuer gratuitement 10 000 trousses d’autodépistage du VIH partout au Canada pour rejoindre les personnes non encore diagnostiquées et les arrimer aux soins. Ce programme a permis de déterminer les facteurs qui influencent l’accès au dépistage et aux soins.

Le Docteur Rourke et son équipe visent à travailler avec des organismes communautaires locaux, des autorités de santé publique et des centres de santé afin de mettre en place et faire fonctionner le programme Notre Boîtesanté. Chaque organisme déterminera les articles qu’il faudra mettre dans les machines pour répondre au mieux aux besoins des personnes de sa communauté. Le lancement de Notre Boîtesanté sur la côte Est est financé par À chance égale, un partenariat entre Bureau en Gros et le MAP Centre for Urban Health Solutions.

« Notre Boîtesanté permettra à des personnes mal desservies de la communauté d’avoir un accès à faible barrière à des ressources qui non seulement réduisent leurs risques d’infections, mais qui peuvent carrément leur sauver la vie », a déclaré Deborah R. Warren, directrice générale d’ENSEMBLE, un organisme communautaire de Moncton, au Nouveau-Brunswick, qui s’efforce de résoudre des problèmes sociaux complexes en offrant des services de soutien, d’éducation et de prévention. « Nous sommes actuellement au beau milieu d’une crise de toxicomanie qui entraîne la mort d’un Néo-Brunswickois tous les quatre jours. L’accès gratuit à la naloxone sauvera de nombreuses vies ».

Notre Boitesanté est financée par les Instituts de recherche en santé du Canada (IRSC), l’Agence de la santé publique du Canada, la Fondation canadienne de recherche sur le sida (CANFAR) et la Fondation de l’Hôpital St Michael, et À chance égale (Bureau en Gros et MAP).

À propos du Centre MAP

Ce centre de recherche de premier plan à l’échelle mondiale se consacre à la création d’un avenir plus sain pour tous. Grâce à des recherches qui donnent une vision d’ensemble et à des solutions concrètes, les scientifiques du Centre MAP s’attaquent à des problèmes de santé communautaire complexes, dont bon nombre se situent au croisement de la santé et des inégalités. Le Centre MAP travaillent en partenariat avec des communautés, chercheurs et dirigeants gouvernementaux partout au Canada pour s’attaquer à des problèmes tels que l’itinérance, l’accès inégal aux soins de santé et à la médecine, et les effets à vie de la pauvreté chez les enfants. Le Centre MAP fait partie du Li Ka Shing Knowledge Institute de l’hôpital St. Michael’s d’Unity Health Toronto. Pour obtenir plus de renseignements, consultez le site maphealth.ca/fr.

À propos de Unity Health Toronto

Le groupement Unity Health Toronto est composé du Providence Healthcare, du Centre de santé St Joseph et de l’Hôpital St Michael. Il s’efforce de faire progresser la santé de chacun dans nos communautés urbaines et au-delà. Notre réseau de santé dessert les patients, les résidents et les clients pour l’ensemble de la gamme des soins, notamment les soins primaires, les soins communautaires secondaires, les services de soins tertiaires et quaternaires pour la phase postaiguë, par la réadaptation, les soins palliatifs et les soins de longue durée, tout en investissant dans la recherche et l’éducation qui sont toutes deux de classe mondiale. Pour de plus amples renseignements, visitez unityhealth.to.

À propos de À chance égale

Staples/Bureau en Gros et MAP ont uni leurs forces pour créer « À chance égale », une initiative visant à sensibiliser le public aux inégalités qui subsistent au Canada et à bâtir des collectivités dynamiques et saines. Le partenariat est fondé sur la conviction partagée que chacun devrait avoir la possibilité de s’épanouir. À chance égale soutiendra la recherche et les programmes du MAP partout au Canada. Il s’agit d’un engagement audacieux à faire une différence dans les collectivités uniques et diversifiées du Canada au moyen de dons d’entreprises, de collectes de fonds et de sensibilisation. Pour de plus amples renseignements, visitez bureauengros.com/achanceegale.

Personne-ressource pour les médias

Hayley Mick ou Jennifer Stranges : communications@unityhealth.to

Lire cet article en français

As 2022 comes to an end, I am delighted to provide an update of MAP’s activity and progress from this past year.

It’s been an extremely productive year, with some major successes and milestones to celebrate! We grew as a centre, worked alongside our community partners to advance many exciting new innovations and solutions, and deepened our policy partnerships and impacts.

In 2022 our team of scientists, investigators and affiliate scientists grew to more than 40, and our MAP research staff now total approximately 130. We brought on two new community scholars, and delivered the second year of our successful BIPOC student program.

Progress on the research front has been exceptional. Our scientists are truly exemplars of MAP’s research pillars of world-leading science and innovation; street-level scalable solutions; and long-term community and policy partnerships.

We are also extremely proud of our national initiative to raise awareness and funds through MAP’s Even the Odds partnership with Staples Canada. Funds raised support MAP’s work in three areas: access to care, ending chronic homelessness, and a healthy start for kids.

I am humbled to lead this amazing enterprise and very grateful for your interest and support. I look forward to what we will achieve in 2023!

Dr. Stephen Hwang
Director, MAP Centre for Urban Health Solutions
Chair, Homelessness, Housing and Health, St. Michael’s Hospital, Unity Health Toronto

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2022 Research Highlights

Dr. Nav Persaud led a task force of MAP scientists to launch the Equity Roadmap report, a set of thirteen recommendations for governments at all levels across Canada. The recommendations outline the interventions/policy changes most likely to address COVID-19-related inequities during Canada’s pandemic recovery period. MAP launched an accompanying podcast series.

Dr. Sharmistha Mishra and Dr. Darrell Tan were among the first to sound the alarm re: the equity implications of mpox public health responses and related stigma, and the importance of global vaccine equity. They worked quickly to launch and complete a mpox vaccine modelling study that provided a roadmap for vaccination.

Dr. Katerina Maximova, the Murphy Family Foundation Chair in Early Life Interventions, led the scale-up of APPLE Schools – A Project Promoting Healthy Living for Everyone in Schools – an internationally recognized “best practice” for school-based interventions for healthy eating, physical activity and mental health in children from socioeconomically disadvantaged communities. Dr. Maximova is bringing a tailored version of the program to 10 new elementary schools in western Canada, with more planned in Ontario.

Dr. Andrew Pinto was awarded the CIHR Applied Public Health Chair in Upstream Prevention in Primary Healthcare AND received $10M from CIHR to develop an adaptive platform trial to evaluate COVID therapeutics in out-patient settings in six provinces across Canada.

Dr. Tara Kiran launched and completed the first phase of OurCare, an ambitious national survey and public consultation platform to capture new perspectives and possibilities for primary care in Canada. The detailed survey garnered >9,000 responses nationally as well as outstanding media coverage.

Dr. Stephen Hwang’s St. Michael’s Hospital Navigator Project expanded to a new site: St. Joseph’s Health Centre in Toronto. The innovative program pairs patients who are homeless with an outreach worker, to help prevent readmission to hospital and ensure a better recovery. The program served approximately 90 unhoused patients in 2022, and was highlighted by the Globe and Mail as a creative, “outside the box” solution to improve access to care.

Dr. Sean Rourke was awarded two large, five-year Public Health Agency of Canada grants for I’m Ready, Our HealthBox and his Positive Effect project to end HIV stigma. I’m Ready also reached a major milestone of >10,000 HIV self-tests distributed across Canada. Dr. Rourke’s new project, I Am, also launched an exciting partnership with Starbucks Canada.

Dr. Dan Werb’s drug-checking service in Toronto has now checked over 7,000 samples of drugs since it launched in Oct. 2019, the majority (50 per cent) of which is fentanyl. Werb’s recent research indicates that more of these kinds of drug-checking services are urgently needed.

Dr. Naomi Thulien premiered Searching for Home, a companion documentary to her Transitioning Youth Out of Homelessness study. The short documentary follows the lives of three young people who are transitioning out of homelessness, and highlights the potential of portable rent subsidies as a novel and promising intervention to help end homelessness.

Want more research updates?

Subscribe to MAP’s Junction e-newsletter for short, monthly updates on our studies, our solutions, and the issues we study. You can also follow MAP on Twitter and LinkedIn, and subscribe to our MAPmaking podcast. MAP scientist were quoted in more than 130 media articles in 2022 – check out the coverage here.

Mise à jour du directeur : bilan de l’année 2022 du MAP

Alors que l’année 2022 touche à sa fin, je suis ravi de vous présenter une mise à jour de l’activité et des progrès du MAP au cours de l’année écoulée.

L’année a été extrêmement productive, avec quelques réussites et étapes importantes à célébrer! Nous avons grandi en tant que centre, avons travaillé aux côtés de nos partenaires communautaires pour faire progresser de nombreuses innovations et solutions passionnantes, et nous avons consolidé nos partenariats et nos impacts politiques.

En 2022, notre équipe de chercheurs, d’enquêteurs et de scientifiques affiliés est passée à plus de 40, et notre personnel de recherche du MAP compte désormais environ 130 personnes. Nous avons engagé deux nouveaux boursiers et nous avons assuré la deuxième année de notre programme d’étudiants PANDC.

Les progrès réalisés dans le domaine de la recherche ont été exceptionnels. Nos scientifiques du MAP sont de véritables exemples des fondements de la recherche de la science et de l’innovation de pointe dans le monde, des solutions évolutives sur le terrain et des partenariats communautaires et politiques à long terme.

Nous sommes également extrêmement fiers de notre initiative nationale de sensibilisation et de collecte de fonds par l’intermédiaire du partenariat À chance égale du MAP avec Bureau en Gros. Les fonds recueillis soutiennent le travail du MAP dans trois domaines : l’accès aux soins, la fin du sans-abrisme chronique et un départ sain pour les enfants.

C’est avec humilité que je dirige cette entreprise extraordinaire et je vous suis très reconnaissant de votre intérêt et de votre soutien. Je me réjouis déjà de ce que nous réaliserons en 2023!

D^r Stephen Hwang
Directeur, MAP
Président, Homelessness, Housing and Health, hôpital St. Michael’s, Unity Health Toronto

July 29 2022 – At the 24^th International AIDS Conference, the world’s largest conference on HIV and AIDS, MAP scientist Dr. Sean Rourke has unveiled a tool that not only eliminates barriers to HIV testing, but connects people to care.

Our Healthbox is “smart”, interactive dispensing machine that provides free, 24/7 access to self-testing kits for HIV as well as COVID-19, naloxone kits, and other essential harm reduction, sexual health and hygiene supplies. The machine also provides health information and a support services directory for people to find the health care they need—in their community.

Dr. Rourke’s REACH Nexus group is planning to launch 25-30 machines nationally this year, with a goal of 100 machines deployed over the next three years. The machines will be hosted and maintained in partnership with local community-based organizations, public health authorities, and health centres across the country.

In Canada, one out of 10 people who have HIV don’t know it. To reach the undiagnosed, Dr. Rourke’s REACH Nexus group launched the I’m Ready program one year ago, an app that enables free, easy access to HIV self-testing kits and support. Since then, the program distributed more than 10,000 self-tests across Canada. However not everyone has a phone, so Our Healthbox was designed to close that gap and meet people where they are.

Our Healthbox and I’m Ready are also health research programs. To access the resources, participants must register and answer a few questions about themselves. The information that is collected remains private and confidential and will help the REACH research team evaluate how well the programs are working.

If you are a community organization and want to place Our Healthbox in your neighbourhood, email ourhealthbox@unityhealth.to.

GLOBE AND MAIL

By Sean Rourke, Trevor Stratton, Notisha Massaquoi And Bill Flanagan

Today in Montreal, Canada’s political leaders are participating the AIDS 2022 conference, bringing the world together to accelerate the fight to end HIV and AIDS globally. Unless their words can be translated into political will and action, we will be no further ahead in ending HIV in Canada.

The number of new HIV cases in Canada has been on the rise over the past five years, and in 2020 (our most recent national estimates of HIV surveillance), four people were infected with HIV every day. However, this is likely an underestimate – we expect to see a higher rate of new HIV infections in 2021 and 2022 because COVID-19 significantly restricted access to HIV testing and treatment.

It is shameful that we are still not getting testing and treatment to those who need it most.

We are among the worst of the G7 countries in making significant progress in achieving the UNAIDS 95-95-95 targets of diagnosing 95 per cent of HIV cases, getting 95 per cent of those people on life-saving treatment, and getting the virus levels of 95 per cent of that group to “undetectable” levels so they can live healthy lives. Most concerning are recent numbers from 2020 that show women are doing worse than men overall in access to testing and treatment – and Indigenous Peoples (First Nations, Métis and Inuit), racialized communities, including African, Caribbean and Black people, and people who use substances and inject drugs, are doing the worst overall.

Having HIV is no longer a death sentence, but people who are infected need to be tested and have access to treatment that will suppress the virus. Unfortunately, one out of 10 people living with HIV is undiagnosed (they have HIV but don’t know it). That’s more than 6,500 people in Canada who are not able to benefit from antiviral treatment. If they don’t get access to testing and are not properly diagnosed, they will get very sick at some point and develop AIDS. And those undiagnosed and without their virus suppressed may also unknowingly infect others.

We have all of the tools and knowledge we need to correct these shortcomings.

In November 2020, we worked to get the first HIV self-test approved in Canada, and then research programs were developed and implemented to provide low barrier access to home testing using technology platforms. But our governments have yet to take up these successful initiatives and scale them sufficiently to reach all of those who are undiagnosed across Canada.

UNITY HEALTH TORONTO

June 1, 2022 — Throughout her nearly 29-year career in research and medicine, Dr. Janet Smylie has focused on addressing health inequities faced by Indigenous peoples in Canada. At its core, her work is about using knowledge to propel change through action.

“In the modern world, we can get away with a focus on knowing and knowledge but where I come from, as a Métis Cree woman and from an Indigenous knowledge perspective, the gap between knowing and doing doesn’t exist,” she says. “The key to reconciliation is bridging the gaps between what we know and what we do. It’s the key to life and to solving most problems.”

Now, the first Strategic Lead of Indigenous Wellness, Reconciliation and Partnerships at Unity Health, Dr. Smylie is bringing that focus into this new role. Over the next seven months, she’ll lead several projects that support Unity Health’s ongoing efforts to develop a strategy and framework for the advancement of Indigenous health and reconciliation across the network.

We sat down with Dr. Smylie, who holds a Tier 1 Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada, to learn more about her new role and the challenges Unity Health faces repairing relationships with Indigenous peoples as a Catholic health care network.

What drew you to this role?

Like many people, I was deeply impacted in June 2021 when the first unmarked graves of Indigenous children were confirmed at a residential school in Kamloops, B.C. At the time, I committed to doing three things – helping address the role of the Catholic Church in the residential school system, marking Indigenous History Month at Unity Health and throwing my hat in the ring for this role. As I get older, having worked in health care for some time, I really try to think about the future. What can I do now to make it better? This role gets at that. But most of all, I was really inspired by those children and their families.

This role was designed with the support of Unity Health’s First Nations, Inuit and Métis Community Advisory Panel (CAP) and is intended to be collaborative in nature, working with the Indigenous community in Toronto. Why are these collaborative efforts so important?

Nothing about us without us. In the Canadian Constitution, First Nations, Inuit and Métis peoples are granted the right to live in a way that builds on the continuity of their respective cultural and societal norms. There’s also a domestic and international legal requirement to involve Indigenous peoples in decisions that affect them. It’s also simply more effective to work with the Indigenous community. No one knows what Indigenous people need more than the Indigenous community.

Do you have any specific goals or priorities in your first couple of months in this role?

One of my first priorities is to build a human resources plan for the network. We’ve heard from the First Nations, Inuit and Métis Community Advisory Panel (CAP) and other community leaders that to become a preferred place for Indigenous peoples to seek care, we need to recruit a team of people who can advance transformational change. This might include an Elder, a cultural coordinator, care navigators and a clinical care lead. Indigenous people often expect that they’ll experience differential or unfair treatment when they visit a hospital. We want Unity Health to be a place where Indigenous people feel safe accessing care.

Another priority of mine is building Indigenous care pathways within our hospitals. Defined referral pathways can be really helpful as they provide comfort and build on the notion of trust relationships.

I’ll also be doing some work with the CAP to develop a renewed terms of reference and explore how we can harmonize the efforts of the CAP and Unity Health’s Council on Anti-Racism, Equity and Social Accountability (CARESA). When working with Indigenous communities, it’s important that we establish a leadership structure and governance model to provide clarity and build trust. I’m working on that too.

Many of your research projects and foundational contributions in Indigenous health have relied on data collection. For instance, you co-led Our Health Counts, a collaborative research project that brought to light missing population-based health information on First Nations adults and children in urban settings. Where did this interest in data collection come from and why is it important?

Early in my career, I was working at an Indigenous health centre in Ottawa and we were trying to set up an information system that would help us understand who was coming into the clinic for care. But over time, I started to worry more about the people who don’t come to us or who only come on occasion and then we don’t see them. I wanted a way to identify these people and assess their health needs. I also just really like math. My dad was a theoretical physicist and I’m not afraid to use math as a tool. These factors motivated me to go back to graduate school at Johns Hopkins University. Then, a colleague introduced me to a new type of sampling that works well to count the people who don’t seek care. Everyone deserves to be counted.

Other early work of mine made sure that First Nations, Inuit and Métis identity was accurately recorded on infant birth and death registrations. Infant mortality is a key indicator of the broader population health of a community. We then discovered that the Canadian census was undercounting the size of Indigenous populations in Toronto by a factor of 3 to 5. Identifying that undercount had an immediate benefit, providing a better match between the unmet needs and aspirations for wellbeing of local First Nations, Inuit and Métis communities and the funding and resources made available.

What are some of the biggest barriers to health care for Indigenous peoples in Toronto?

There are approximately 90,000 First Nations, Inuit and Métis peoples living in Toronto and about 90 per cent are living under the low income cut off. Many of these individuals are young people or single caregivers, which can make it difficult to access care. For example, if you need to take the TTC with multiple children in-hand to access care, this makes it much more difficult than if you have a car and childcare. Another barrier, perhaps the biggest one, is a lack of trust in the health care system. There’s a lot of fear among Indigenous peoples that they’ll be treated differently because they’re Indigenous. Some other common barriers are a lack of access to regular primary care providers and not knowing where to seek care. There are also challenges navigating the transportation system.

It’s been nearly two years since Joyce Echaquan, a 37-year-old mother and member of Atikamekw Nation of Manawan, died in a Joliette, Que. hospital after staff dismissed her symptoms and subjected her to racist language and behaviour. A few days later, you co-authored an opinion piece in the Globe and Mail on racism in the medical system. Have we seen any improvements in the system since then?

No. Unfortunately, slow progress with respect to tangible change is a common challenge in systems transformation work – we could ask the same question about anti-Black racism and discrimination towards members of the 2SLGBTQ+ community. We know what works but we don’t have the political will to act on our knowledge. Human beings are funny that way – it’s hard for us to change our minds or act differently.

The Catholic Church was a leader in colonization and ran most of Canada’s residential schools. Unity Health Toronto is one of Canada’s largest catholic health care networks. How does our identity and affiliation with the church change the work we have to do?

First Nations, Inuit and Métis peoples have a complicated relationship with the church because of the role that the church played as a leader in the colonization of the Americas. Every person and community has navigated that relationship in their own way and we respect those ways of navigation. Some people feel safe and happy at Unity Health, while others could be triggered or feel uncomfortable given the legacy of multi-generational harms stemming directly from the policies and actions of the church. We need to figure out how to support that range of responses so that people say “Yes, this is a Catholic hospital but they did something good for my relative.”

Pope Francis is expected to visit Canada in July to meet residential school survivors and deliver an apology on Canadian soil for the church’s role in running residential schools. What does this visit mean to Indigenous peoples?

It’ll mean many different things to different First Nations, Inuit and Métis people. For some survivors of the residential school system and their families, it’ll bring healing and relief from pain. For others, it could bring pain and anger. I think it’s an important step though. If this visit helps anybody, it should happen. Where I come from, restorative justice is important; we need to acknowledge wrongdoing. I hope that’s what this visit represents. It’s what a lot of people wanted and a step in the right direction.

Do you have any advice for those who want to learn more about Indigenous history and culture or who want to help build and repair relationships but are afraid of offending others?

One of the best things people can do is learn more about cultural safety. The San’yas Anti-Racism Indigenous Cultural Safety Training Program, which many staff at Unity Health have completed, has shown to be better than a placebo when measuring how likely Indigenous patients are to recommend someone as a health care provider. I also encourage people to find a peer and read the summary report of the Truth and Reconciliation Commission. It’s painful but we need to be witnesses. It’s also good to attend events celebrating Indigenous people, if the community is willing to share. After the event, spend some time self-reflecting on what it was like to be there. And remember that this is a learning journey.

This interview has been edited and condensed.

By: Anna Wassermann

THE CONVERSATION

Co-written by Dr. Jesse Jenkinson

Visible homelessness during the COVID-19 pandemic has highlighted the housing crisis across Canada. For women, girls and gender-diverse people, homelessness is often hidden, meaning that they are more likely to avoid shelters, couch surf or remain in abusive relationships than end up on the streets. Because of this, we know less about their experiences.

New data from the Pan-Canadian Women’s Housing and Homelessness Survey, the largest gender-specific data collection of its kind in Canada, tells us a clear story.

Lack of access to housing has gendered causes and effects, and gender equality in Canada depends on fair access to adequate housing. This survey, completed by 500 women and gender-diverse people in 12 provinces and territories, shows us why housing is a women’s rights issue.

TORONTO STAR

By Tara Kiran, Noah Ivers, Sabina Vohra-Miller

We all want the pandemic to be over. Last week, that dream came closer to reality.

Pfizer released a statement showing an effective and safe vaccine in children aged 5 to 11. Pfizer will soon submit the full data package to Health Canada and If the data is considered sufficient, and no concerns are identified, the vaccine could be approved for this age group as early as Halloween.

A COVID-19 vaccine for children is a game-changer. It not only protects our kids from getting COVID-19 and its related complications, it also protects their loved ones and the wider community. It will limit transmission of the virus—preventing classes from being sent home, allowing a return to sports and other activities, and reduces the risk of unknowingly passing the virus on to someone more vulnerable like a grandparent.

But the vaccine only works if people get it.

We must work quickly to get the largest number of kids vaccinated as fast as possible—and ensure an equitable roll-out prioritizing those most at-risk. The most efficient and effective way to do so is by bringing vaccines to schools.

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UNITY HEALTH TORONTO

A new paper published by Unity Health Toronto researchers found most adults experiencing homelessness have faced an incredible burden of childhood trauma.

The paper, published in Lancet Public Health, found nine in 10 homeless adults have been exposed to at least one adverse childhood experience and over half have been exposed to four or more adverse childhood experiences. Previous research in the general population has shown that those exposed to four or more childhood traumas were 17 times more likely to have attempted suicide than those who had not experienced trauma in childhood.

Michael Liu, lead author of the study, is a research coordinator at St. Michael’s MAP Centre for Urban Health Solutions, a medical student at Harvard University and a Rhodes Scholar. We spoke with Michael, a Toronto native, about the systematic review and meta-analysis and why he says services must be trauma-informed and there must be a greater emphasis on early-intervention.

The paper sought to answer the question: how often have adults experiencing homelessness had an adverse childhood experience? Why is this important to investigate?

There’s lots of literature on adverse childhood experiences in the general public, but I think this is a really under-appreciated aspect of homelessness. Adverse childhood experiences encompass potentially traumatic events occurring before the age of 18 years, such as abuse, neglect, and household dysfunction.

In the late 1990s, studies showed us that early trauma affects health throughout one’s entire life course. The accumulation of toxic stress affects just about everything – from our mental health to chronic disease. We know that toxic stress can lead to disrupted brain development, with long-term consequences for learning, behaviour, and broad social outcomes. So we wanted to understand how big of a problem is early trauma in the homeless population, and if it is, what can we do about it? What do policymakers need to know?

Selon une méta-analyse, 90 % des adultes vivant en situation d’itinérance ont subi un traumatisme pendant leur enfance

Un nouvel article publié par des chercheurs de Unity Health Toronto a révélé que la plupart des adultes sans domicile fixe ont subi de lourds traumatismes pendant leur enfance.

L’article, publié dans la revue Lancet Public Health, a révélé que neuf adultes sans domicile fixe sur dix ont été exposés à au moins une expérience négative dans leur enfance, tandis que plus de la moitié ont été exposés à quatre expériences négatives ou plus. Des recherches antérieures menées auprès de la population générale ont montré que les personnes exposées à quatre traumatismes ou plus durant l’enfance étaient 17 fois plus susceptibles de faire une tentative de suicide que celles qui n’avaient pas subi de traumatisme à cette époque.

Auteur principal de l’étude, Michael Liu est coordonnateur de recherche au Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael, étudiant en médecine à l’Université Harvard et boursier Rhodes. Nous avons discuté avec Michael, originaire de Toronto, de l’examen systématique et de la méta-analyse ainsi que des raisons pour lesquelles il estime que les services doivent tenir compte des traumatismes et insister davantage sur l’intervention précoce.

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HEALTHY DEBATE

By Zoë Dodd, Samantha Young, Lisa Boucher, Abeera Shahid, Melanie Brown, Kimia Khoee, and Ahmed Bayoumi

While people have been living in encampments for decades, they have never been as visible as during the COVID-19 pandemic. The City of Toronto has also been dismantling encampments for a long time – more than 700 were dismantled in 2019 – but never as forcefully as this year. Yet, in all of the discussions about how politicians, police and city workers should respond to encampments, there has been little effort to understand why encampments exist and what they mean to people living in them.

As researchers at MAP Centre for Urban Health Solutions at Unity Health Toronto, we have been studying outreach services provided to people who live in encampments. As part of a large study of the effects of the response to the COVID-19 pandemic on people experiencing marginalization, we surveyed 127 residents of Toronto’s Trinity Bellwoods, Alexandra Park, Lamport Stadium, Moss Park, Cherry Beach and Sanctuary encampments between March and June 2021 (and before the most recent evictions in July 2021). While our full report will be released in October, we believe it pertinent to release these preliminary findings to add to the current conversation on encampment evictions.

Overall, our findings suggest that the story of encampments is complex. Five results of our survey are especially important and may contradict commonly held assumptions.

La vie dans les campements est bien plus qu’un simple problème lié à la pandémie, selon des chercheurs

Par Zoë Dodd, Samantha Young, Lisa Boucher, Abeera Shahid, Melanie Brown, Kimia Khoee et Ahmed Bayoumi

Bien que des gens vivent dans des campements depuis des décennies, ils n’ont jamais été aussi en évidence que pendant la pandémie de COVID-19. La Ville de Toronto démantèle depuis des années des campements (plus de 700 l’ont été en 2019), mais jamais d’une façon aussi énergique que cette année. Malgré toutes les discussions sur la façon dont les politiciens, la police et les employés municipaux devraient réagir à la présence de campements, peu d’efforts ont été faits pour comprendre la raison d’être de ces derniers et ce qu’ils signifient pour les personnes qui y vivent.

En tant que chercheurs du Centre MAP pour des solutions de santé urbaine de Unity Health Toronto, nous avons étudié les services de proximité fournis aux personnes qui vivent dans des campements. Dans le cadre d’une vaste étude sur les effets des mesures liées à la pandémie de COVID-19 sur les personnes en situation de marginalisation, nous avons interrogé 127 résidents des campements de Trinity Bellwoods, d’Alexandra Park, du Lamport Stadium, de Moss Park, de Cherry Beach et de Sanctuary à Toronto entre mars et juin 2021 (et avant les expulsions les plus récentes en juillet 2021). Notre rapport complet sera publié en octobre, mais nous pensons qu’il est pertinent de diffuser ces conclusions préliminaires pour enrichir le débat actuel portant sur le phénomène des expulsions de campements. Dans l’ensemble, nos résultats suggèrent que le dossier des campements est complexe. Cinq résultats de notre enquête sont particulièrement importants et sont susceptibles de démentir des hypothèses largement répandues.

September 28, 2021                               

Re: Planning and Housing Committee Item PH25.10 – New Regulatory Framework for Multi-Tenant Houses

We would like to acknowledge this matter was brought to our attention by individuals with lived experience in Multi-Tenant Houses who have raised this as an area of community priority.

We are health care providers, scientists and researchers who work in association with MAP Centre for Urban Health Solutions at St. Michael’s Hospital. We live in all areas of the city, and are united in our concern about the lack of good quality, permanent and deeply affordable housing in Toronto. We are pleased that the City of Toronto has put forth a framework to permit and regulate Multi-Tenant Houses across the city, and we expect the Mayor and Councillors who represent us to support this framework. We are calling on our Mayor and City Councillors to support the motion to regulate Multi-Tenant Houses across Toronto at the October 1^st, 2021 session of City Council. We will be contacting our Councillors about this motion, and encouraging our co-workers, neighbours and community to do the same.

Multi-Tenant Houses (MTH), also known as rooming houses, have long been part of Toronto’s housing structure and make a significant contribution to the limited affordable housing stock in our city. A diverse cross-section of people rely on this housing stock, including people with lower incomes, students, recent immigrants, migrant workers, and people with disabilities.

In 1998, the provincial government amalgamated six municipalities to create the new “mega city” of Toronto. While MTH had been legally permitted in some of these municipalities, such as the old city of Toronto, they were not permitted in the former cities of North York, East York and Scarborough. More than 20 years later, Toronto has still not harmonized by-laws across the city, and MTH are still not technically allowed to exist in some areas.

This doesn’t mean they don’t exist—they do and always have. Instead, it means that tenants living in unregulated and unlicensed MTH have fewer options to protect their health and safety. This has ripple effects for the surrounding communities, which are much safer when MTH are regulated.

According to City of Toronto data, licensed MTH are far safer than unlicensed MTH. For instance, between the years 2010 to 2020, there were 18 MTH that were involved in fire fatalities and serious injuries, 16 of which were unlicensed. Additionally, the vast majority of MTH charges laid by Municipal Licensing & Standards are in neighbourhoods where they are not permitted. The Maytree Foundation’s human rights review of  Toronto’s MTH policies also reported that individuals living in MTH in unpermitted areas are less likely to report substandard conditions and, therefore, live at greater risk of harm to their health and personal safety. Unpermitted houses are also more likely to violate existing regulations (i.e., the Ontario Building Code).

As health care providers and researchers, we see the impacts of sub-standard housing and housing instability on wellbeing, and on mental and physical health. We also know that when someone loses their housing, it has adverse consequences for their lives, families and communities. For instance, research suggests that when people experience involuntary loss of housing, they are more likely to also lose their job. We know that MTH often provides the only affordable option in the private housing market, and can potentially help people avoid homelessness.

Research on permitted MTH has shown that people of lower socioeconomic background and with existing health conditions have often resided in houses that are in poor physical condition. This is likely even worse for houses that are unpermitted. Good housing quality is critical for health—factors such as adequate space allocation, indoor air quality and proper waste and pest management are essential for disease prevention, especially in congregate living settings.  Permitting and regulating MTH in unpermitted areas will create a means for the City to enforce quality standards across the City, which will ultimately benefit both tenants and surrounding communities.

The City staff report notes that the proposed framework will aim to take a phased approach that will include education and outreach to tenants on their rights, as well as support for landlords to meet property standards. We applaud the City for including this in their plan as it can help sustain existing MTH and provide opportunities to invest in improving this affordable housing stock.

From our vantage point within the health care sector, we would also like to share the following recommendations with City Council:

1. Establish equitable support services to help MTH tenants retain their housing and assist qualifying landlords retain their homeownership once their area of the city is regulated. This could be achieved through collaboration with community agencies as well as establishing grant programs.
2. Ensure that enforcement of the new regulations does not further harm and marginalize groups who are likely to live in MTH —this will be key to meeting the City’s human rights approach.
3. At implementation, continue to engage in the multi-divisional cross collaboration (Fire Services; Toronto Building, Municipal Licensing & Standards; City Planning; Toronto Public Health) that was used to develop the new framework.  This collaboration will contribute to the development of a more robust policy practice in relation to housing, health and community safety. 

Ultimately, a harmonized MTH regulation can help improve current policy and practices and will allow for this affordable housing stock to be better integrated within our housing continuum.

We commend the City for taking steps to solving this long standing equity issue in our city. We encourage the City to continue to consult the community in finding ways to sustain and strengthen the quality of this affordable housing stock and ask the Mayor and City Council to support the regulation of MTH across Toronto at the upcoming Council meeting. This will align with the City’s commitment to advance a human rights based approach to housing as outlined in Housing TO 2020-2030 Action Plan.

What You Can Do

Call Your City Councillor and the Mayor: Members of Council Contact Information

Sign Community petition: The Federation of Metro Tenants’ Associations (FMTA)

Take the ACTO and CERA survey on Multi-Tenant Housing: Survey  

Find More Information

City of Toronto: Multi-Tenant (Rooming) Houses Maytree Foundation: A Human Rights Review of Toronto’s Multi-Tenant Homes Policies

Signed by health care providers, scientists and researchers who work in association with MAP Centre for Urban Health Solutions at St. Michael’s Hospital:

1. Stephen Hwang, Director, MAP Centre for Urban Health Solutions, Unity Health Toronto
2. Ann Burchell, Scientist
3. Andrew Pinto, Scientist and Physician
4. Jesse Jenkinson, Postdoctoral Research Fellow
5. Uzma Ahmed, Research Coordinator
6. Galo F. Ginocchio, Research Coordinator
7. Olivia Spandier, Research Coordinator
8. Y. Celia Huang, Research Coordinator
9. Ashley Mah, Research Co-ordinator
10. Triti Khorasheh, Research Coordinator
11. Madison Ford, Research Coordinator
12. Anaita Kharwanwala, Administrative Assistant
13. Anna Yeung, Research Manager
14. Nav Persaud, Scientist, Family Physician, Canada Research Chair in Health Justice
15. Flora Matheson, Scientist
16. Ruby Sniderman, Research Manager
17. Kimberly Devotta, Research Manager
18. Alexandra Carasco, Research Coordinator
19. Evie Gogosis, Research Manager
20. Aine Workentin, Research Coordinator
21. James Watson, Research Manager
22. Andree Schuler, Research Associate
23. Ahmed Bayoumi, Fondation Baxter and Alma Ricard Chair in Inner City Health, MAP Centre for Urban Health Solutions, Unity Health Toronto
24. Fred Ellerington, Homeless Outreach Counsellor
25. Zoe Dodd, MES, Community Scholar
26. Vera Dounaevskaia , MD
27. Rosane Nisenbaum, Biostatistician
28. Dr. James Rassos, GIM Staff Physician
29. Jessica Demeria, Indigenous research coordinator
30. Sharmistha Mishra, Infectious Disease Physician and Associate Professor, University of Toronto
31. Anne-Marie Tynan, Research Program Manager
32. Jemal Demeke, Research Coordinator
33. Mackenzie Hamilton, Junior Data Science Specialist
34. Kate Francombe Pridham, Research Program Manager, Homelessness, Housing, and Health
35. Ketan Shankardass, Affiliate Scientist
36. Cheryl Rowe, Community Psychiatrist
37. Stefan Baral, Family and Population Health Physician, Inner City Health Associates
38. Suzanne Shoush, Graduate student, Staff Physician, St. Michael’s Unity Health
39. Ayan Yusuf, Research Coordinator
40. James Kitchens, Staff Physician, St. Michael’s Hospital
41. Nazlee Maghsoudi, Research Manager
42. Angela Onkay Ho, Psychiatrist
43. Mara Waters, Internal medicine resident
44. Tracy Rook, Registered Nurse
45. Melissa Capozzolo, Registered Practical Nurse
46. Shazeen Suleman, Investigator
47. Aaron Orkin, Physician
48. Nigel Champion, Resident Doctor
49. Emily Holton, Communications Manager
50. İrem Burcu Baltaş, Registered Nurse
51. Gillian Kennedy, Registered Nurse
52. Michelle Catchpole, Research Business Analyst
53. Charles Ozzoude, Researcher
54. Roisin McElroy, MD CCFP(EM)
55. John Ecker, Research Manager
56. Brooke Fraser , Internal medicine resident – PGY2 
57. Carol Munroe, Medical Admin Administrator
58. Erica Di Ruggiero, Associate Professor
59. Kristy Yiu, Research Coordinator
60. Peter Gozdyra, Visiting Researcher
61. Naheed Dosani, Lecturer, Department of Family & Community Medicine, University of Toronto
62. Madeleine Ritts, Social worker
63. Suzanne Zerger, Research Program Manager
64. Billie-Jo Hardy, Scientist, WIHV, Women’s College Hospital
65. David Reycraft , Director – Housing Services Dixon Hall Neighbourhood Services
66. Sara Pickersgill, MD
67. Andrea A. Cortinois, Assistant Professor, University of Toronto
68. Deborah Pink, Physician
69. Asha Aggarwal, Social Worker
70. Paul Zijlstra, Registered Practical Nurse
71. Lisa Forman, Associate Professor, Dalla Lana School of Public Health, University of Toronto
72. James Lachaud, Postdoctoral researcher
73. Luke Hays, Emergency Doctor
74. Darryl Langendoen, Social Worker
75. Opal Sparks, Advocate
76. Rene Adams, Community Expert
77. Samantha Green, Family Physician, Inner City Health Associates and Unity Health Toronto
78. Maryam Daneshvarfard, Research Coordinator
79. Carol Strike, Professor/Scientist
80. Heather McLean, Research Assistant I
81. Emilie Frenette, NP-PHC
82. George Da Silva, Person who was homeless (Peer Research Assistant)
83. Jesse Knight, PhD Candidate
84. Veronica Snooks, Community Expert Group member, Dream team member, PWLE caucas member
85. Terry Pariseau, Coordinated Access Engagement Coordinator
86. Denise Gastaldo, Associate Professor, University of Toronto
87. Sa’ad Talia , Community Expert Group Research Consultant
88. Veronica van Dam, Nurse practitioner
89. Gary Bloch, Family Physician; Associate Professor, University of Toronto
90. Elizabeth Harrison, Registered Nurse
91. Adam Suleman, Resident Physician
92. Daniela Mergarten, Co-Chair of the lived experience caucus of the Toronto Alliance to End Homelessness
93. Pearl Buhariwala, Research Coordinator
94. Yue Chen, Junior Data Scientist
95. Nicole Champagne, Social Worker
96. Kira Heineck, Executive Director, Toronto Alliance to End Homelessness
97. Chan Drepaul, Program Manager
98. Dr Laura Pacione, Child and Adolescent Psychiatrist
99. Drew Silverthorn, Community Mental Health Social Worker
100. Arthur McLuhan, Postdoctoral Research Fellow
101. Amy Katz , Knowledge Translation Specialist
102. Kim Chamberland, Registered Nurse
103. Bee Lee Soh, Community Expert Group member
104. Dr. Farah N. Mawani, Postdoctoral Fellow
105. Vikram Jayanth Ramalingam Research Assistant
106. Reena Pattani, Physician
107. John Sollazzo, Emergency Physician
108. Alyssa Ranieri, Homeless Outreach Counsellor
109. Christina HW Kim, Resident Physician
110. Wale Ajiboye, Senior Research Associate
111. Philip Garwood, Resident Doctor