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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

THE CONVERSATION

By Drs. Stephen Hwang and Jesse Jenkinson

The number of people visibly living in encampments has increased throughout the COVID-19 pandemic. This has led to cities — including Toronto, Victoria and Vancouver — to work with encampment residents to move them into shelters, hotel spaces and more rarely, stable housing.

When those offers are declined, the next step can be the removal of residents’ belongings, and sometimes — such as recent events in Toronto and Halifax — violent evictions by police.

As researchers who work to improve the health and well-being of people who experience of homelessness, we are deeply concerned about the long-term consequences of this approach. Not only is it morally questionable to punish the most vulnerable, it isn’t an effective strategy for addressing homelessness. Criminalizing poverty doesn’t work.

The first step in addressing this problem is understanding the answer to this basic question: Why are some people in encampments insisting on staying where they are?

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From the Toronto Star article:

…Some schools are also being supported by external programs, like the Model Schools Pediatric Health Initiative run out of St. Michael’s Hospital in Toronto and Unity Health, which serves over 50 inner city schools through clinics based in Sprucecourt Public School and Nelson Mandela Park Public School. Dr. Sloane Freeman, a pediatrician and lead of the clinics, said she anticipates “a storm of referrals” as schools reopen for in-school learning.

“It’s very difficult to identify kids’ needs virtually, whether it be educational needs, mental health needs or developmental health needs,” Freeman said, adding that features of ADHD and autism, for example, are much harder to pick up on through a screen.

Freeman said she anticipates some children returning to the classroom will display symptoms of anxiety and depressed moods, but also problems with emotional outbursts. “We’ve always seen challenges with kids’ self-regulation and having a hard time managing big emotions, and I think we’re going to see more of that.”

Les écoles se préparent à une hausse de la demande de services en santé mentale avec la reprise des cours en présentiel

Extrait de l’article du Toronto Star :

… Certaines écoles sont également soutenues par des programmes extérieurs, comme le Model Schools Pediatric Health Initiative de l’hôpital St. Michael de Toronto et Unity Health, qui dessert plus de 50 écoles du centre-ville avec ses cliniques établies dans les écoles publiques Sprucecourt et Nelson Mandela Park. La docteure Sloane Freeman, pédiatre et responsable des cliniques a déclaré qu’elle s’attendait à une « foule de demandes de consultation » avec la réouverture des cours en présentiel.

« Il est très difficile de définir les besoins des enfants de manière virtuelle, que ce soit en matière d’éducation, de santé mentale ou de santé développementale », a déclaré la D^re Freeman, ajoutant que les particularités du TDAH et de l’autisme, par exemple, sont beaucoup plus difficiles à déceler à travers un écran. La D^re Freeman a déclaré s’attendre à ce que certains enfants retournant en classe présentent des symptômes d’anxiété et d’humeur dépressive, mais aussi des problèmes de débordements émotionnels. « Les défis liés à l’autorégulation chez les enfants et à la difficulté de gérer les émotions fortes ont toujours été présents, et je pense que nous en verrons davantage. »

THE GLOBE AND MAIL

By Sloane Freeman and Ripudaman Singh Minhas

When schools reopen in September, they will need to answer difficult questions in the face of ongoing challenges from COVID-19. And in doing so, they will also need to take into account that the pandemic affected school-aged children in different ways.

The duration of school closures varied across provinces and territories – Ontario, for instance, experienced the longest shutdown at 26 weeks. How will that varied length affect children in different areas? It is anticipated that Canadian students will return to school this fall with greater mental and physical health needs, as well as significant learning gaps – but children facing socioeconomic instability have been most affected. How will schools be equipped and resourced to support returning students’ additional needs? Similarly, will schools have the capacity to meet the learning needs of students who have fallen substantially behind?

From the CTV News piece:

Canada’s street supply of opioids is becoming increasingly toxic, unpredictable and contaminated thanks to ultra-potent and deadly mixtures of fentanyl, prompting renewed calls for safe supply programs that could help regain control of the drug supply and save lives.

It’s believed pandemic border closures have played a role in disrupting the supply chain, prompting the creation of new, more lethal cocktails.

“We’re absolutely losing control of the drug supply, and it’s causing people to die,” Karen McDonald, lead of the Toronto drug-checking service operated by St. Michael’s Hospital, told CTV National News.

“Fentanyl can be used safely … but it can’t be used safely when you have no idea how much fentanyl is in it.”

Launched in 2019 in response to the growing opioid epidemic, Toronto’s anonymous drug-checking service offers drug users detailed information on the contents of their drugs in a bid to reduce overdoses.

From the CBC Radio piece:

…A solution might come from Dr. Dan Werb, an epidemiologist and executive director of the Centre on Drug Policy Evaluation in Toronto.

Over the last four years, he has been developing a cheaper, portable drug-testing device alongside Dr. Drew Hall, a colleague from the University of San Diego where Werb is an assistant professor.

“We’re academics, we’re scientists,” Werb told Day 6 host Brent Bambury, “I’m [not] a technologist, so I think we’re coming at this from a different angle.”

The device, called DoseCheck, is about the size of a smartphone, Bluetooth-enabled and made up of a circuit board, sensor and battery.

When voltage runs through the sensor, different drugs create peaks at different voltages. Each peak’s height signals the concentration of that drug within the sample. Sensors can be changed to detect new contaminants as they’re discovered in the drug supply.

That data is then sent to a smartphone app which performs the analysis and gives the user a breakdown of the drug.

In 2019, the device was announced as a finalist in Health Canada’s Drug Checking Technology Challenge, launched a year earlier to encourage innovations in harm reduction.

Werb said that drug-checking technologies aren’t widely available, and the machines that are remain pricy because of a lack of interest from companies.

“It’s a non-viable business model for major technology companies,” he said. “People who are structurally vulnerable and using drugs, and frontline harm-reduction workers, that’s not a huge market.”

Werb expects DoseCheck will retail between $300 and $350, a price he hopes will be friendlier to centres like VANDU who don’t receive federal funding for drug checking. It is expected to hit the market within the next year to 18 months.

He also hopes DoseCheck will extend access to drug testing into Canada’s more remote areas.

From the Toronto Star piece:

…Parvin Merchant, a director of support services for Houselink and Mainstay, also became concerned about the seemingly premature deaths of residents and added up the names.

The results prompted her to reach out recently to a contact at St. Michael’s Hospital. She wanted someone to explore the circumstances of the formerly homeless who are dying unexpectedly in supportive housing across the city.

Are there strategies that can be used to reduce the death toll, she wondered.

Dr. Stephen Hwang, a research scientist, and James Lachaud, a research fellow and whose expertise includes urban housing and vulnerable populations, liked Merchant’s idea.

In fact the two were so impressed they’ve decided to apply for a $75,000 federal research grant to study premature aging and premature mortality among people living in supportive housing across the city.

…Lachaud submitted the grant application and Hwang is a co-applicant. They are still awaiting word on whether they’ll win the grant.

Lachaud says he believes the number of deaths from people who are alone is troubling.

Once housing is found for homeless people, social isolation and loneliness can become a major concern and an important risk factor for common mental health disorders, such as depression, anxiety, substance use and suicidal thoughts, Lachaud says.

“Inadequately treated physical and mental health conditions can lead to premature and avoidable deaths. Unfortunately, formerly homeless, single older adults living in supportive housing have been dying alone (in their homes) for years, and this phenomenon has been largely ignored,” Lachaud went on to say.

The experts from St. Michael’s Hospital, Merchant, Mainstay and Houselink and other non-profits who support the homeless, mentally ill and substance users will be taking part in the study if it goes forward, including sharing data.

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THE TORONTO STAR

By Dr. Tara Kiran with contributor Dr. Danielle Martin

Imagine moving to a new city and automatically joining a local health-care team, just like children join their neighbourhood school. What if every Canadian had access to a social worker or pharmacist through a family practice team and could easily reach them via phone, video call or email?

The health of Canadians depends on easy and equitable access to high-quality primary care that is integrated with other parts of the health-care system. The need has never been more urgent.

During the pandemic, most doctor’s offices were open, but many Pap tests, diabetes visits and routine immunizations were delayed as patients understandably waited for lower case counts and vaccines. We now face a backlog of missed chronic disease and preventive care.

Additionally, more Canadians are facing mental health and addiction challenges that need primary care attention.

Reconstruire en mieux : Tous les Canadiens devraient avoir un médecin de famille

Par la D^re Tara Kiran, avec la collaboration de la D^re Danielle Martin

Imaginez déménager dans une nouvelle ville et intégrer automatiquement une équipe de soins de santé locale, tout comme les enfants intègrent l’école de leur quartier. Et si chaque Canadien avait accès à un travailleur social ou à un pharmacien par l’intermédiaire d’une équipe de médecine familiale et pouvait facilement les joindre par téléphone, appel vidéo ou courriel?

La santé de la population canadienne repose sur un accès facile et équitable à des soins primaires de haute qualité, intégrés aux autres volets du système de soins de santé. Le besoin n’a jamais été aussi pressant.

Durant la pandémie, la plupart des cliniques médicales sont demeurées ouvertes, mais de nombreux tests de routine comme le dépistage du cancer du col de l’utérus, les suivis pour la gestion du diabète et pour la vaccination ont été retardés, parce que les patients attendaient, à juste titre, que le nombre de cas diminue et que les vaccins soient administrés. Nous faisons maintenant face à un retard considérable dans le traitement des maladies chroniques et des soins préventifs. En outre, de plus en plus de Canadiens sont aux prises avec des problèmes de santé mentale et de toxicomanie qui nécessitent le recours aux soins primaires.

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TVO.org speaks with MAP Director Dr. Stephen Hwang about hidden homelessness, encampments, our Beyond Housing network — and making sure people get the supports they need.

From the TVO.org piece:

Hwang: “We’ve made progress. Things have changed dramatically over the course of the pandemic. And we’re now at a tipping point, because we’re in a new situation that can’t just be sustained as the new status quo. We’re going to either go forward and solve some of these problems permanently or we’re going to just go back to the way things were, and it’ll be even worse than it was before. I think it’s really impossible to imagine that we will go back. Before, we could imagine that homelessness would just kind of grumble along the same way it always had, and nothing would change, except around the edges. Now I think that things have changed, and the system has been destabilized in a way that means we will either make substantial progress toward addressing the problem or things will get even worse. That’s my take on it.”

Comment s’attaquer au problème de l’itinérance en Ontario : Entrevue avec le docteur Stephen Hwang

TVO.org s’entretient avec le directeur du MAP, le docteur Stephen Hwang, au sujet de l’itinérance cachée, des campements, de notre réseau Beyond Housing – et de la nécessité de veiller à ce que les gens obtiennent le soutien dont ils ont besoin.

Tiré de l’article de TVO.org :

Hwang : « Nous avons réalisé des progrès. La situation a radicalement changé au cours de la pandémie. Nous nous trouvons maintenant à un point de non-retour, car nous vivons une nouvelle réalité qui ne peut pas être considérée comme le nouveau statu quo. Soit nous allons de l’avant et nous résolvons certains de ces problèmes de façon permanente, soit nous revenons à la situation antérieure, ce qui serait encore pire. Je crois qu’il est tout à fait impensable de retourner en arrière. Auparavant, nous pouvions imaginer que le phénomène de l’itinérance continuerait d’exister comme naguère et que rien ne changerait, du moins en apparence. Maintenant, je pense que la situation a évolué et que le système a été déstabilisé d’une manière telle que soit nous ferons des progrès substantiels pour résoudre le problème, soit la situation continuera de se détériorer. C’est ainsi que je vois les choses. »