Author: Samira Prasad

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From Unity Health Toronto

The SPRinG app, designed in partnership with community groups and people who have experienced problem gambling, is a low-barrier, self-management journaling and tracking tool that helps users understand their gambling patterns and urges. It’s a research tool to gain insights into this population, and explore the feasibility of addressing problem gambling with a digital solution.

Problem gambling is associated with a range of health concerns, including substance use, mental illness, chronic illness and disability. Research suggests that prevalence of problem gambling among people experiencing homelessness is up to 58 per cent, nine times higher than the general population.

Dr. Flora Matheson is a Research Scientist, Dr. Arthur McLuhan is a Senior Research Associate, and Madison Ford is a Research Coordinator at MAP Centre for Urban Health Solutions. Dr. Alireza Sadeghian is a professor at the Department of Computer Science at Toronto Metropolitan University. They spoke about leading the SPRinG project, the questions they’re hoping to answer and why they’re passionate about this work.

Q: How does the SPRinG app work?

Ford: The app centres around users journaling about their gambling urges and gambling events, and the circumstances surrounding those urges and events. All of this information is collected through the app, allowing users to learn about their behaviour. For example, users can track their location during a gambling urge, how much money they’ve lost in gambling events for the past week, and how this compares to previous weeks. All of these variables help users identify triggers and high-risk situations and develop strategies for managing them.

When users are experiencing an urge, the app offers them four options to deter them from gambling: 1) engage in a distraction, 2) contact a friend, 3) engage in alternate activities and 4) contact a 24/7 crisis line.

Q: How did you develop the app?

Matheson: It started with initial funding from the Ontario Ministry of Health to develop a prototype about five years ago, and now we’re at the recruitment stage. We’ve received subsequent funding from the Natural Sciences and Engineering Research Council of Canada, and the Canadian Institutes of Health Research through the Collaborative Health Research Projects Initiative.

At MAP, we have a research program that looks at the connections between problem gambling, homelessness and poverty.

In Ontario, there are not enough gambling support services for those who need them. These services are often siloed, and many have long wait lists. Our community partners wanted a tool that could bridge these services, and could be accessed outside of normal 9-5 business hours, when a gambling event is likely to occur. This could be at 5 p.m., when a friend calls asking to go to the casino, or on the weekends, when support services might be closed. The app is always there in users’ back pockets, whenever they need it.

Une application conçue par des chercheurs de St. Michael’s offre un soutien 24 heures sur 24, 7 jours sur 7, aux personnes ayant des problèmes de jeu

Conçue en partenariat avec des groupes communautaires et des personnes ayant connu des problèmes de jeu, l’application SPRinG est un outil convivial d’autogestion qui permet aux utilisateurs de suivre et de consigner des données pour mieux comprendre leurs habitudes et leurs envies de jeu. Il s’agit d’un outil de recherche servant à mieux connaître cette population et à explorer la faisabilité d’une solution numérique pour lutter contre la dépendance au jeu.

La dépendance au jeu est associée à toute une série de problèmes de santé tels que la toxicomanie, les maladies mentales, les maladies chroniques et l’invalidité. Des études suggèrent que la prévalence des problèmes de jeu chez les personnes en situation d’itinérance s’élève à 58 %, ce qui est neuf fois plus élevé que dans la population générale.

Flora Matheson est chercheuse, Arthur McLuhan est associé de recherche principal et Madison Ford est coordonnatrice de la recherche au Centre MAP pour des solutions de santé urbaine. Alireza Sadeghian est professeur au département d’informatique de l’Université métropolitaine de Toronto. Ils nous parlent de la direction du projet SPRinG, des questions auxquelles ils espèrent répondre et des raisons pour lesquelles ce travail les passionne.

From CBC The National

Dr. Sean Rourke speaks to CBC about the alarming increase in syphilis cases in newborn babies in Canada, why rural Indigenous communities are particularly vulnerable, and how a new rapid test could help:

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Letter to the editor in the Toronto Star, by Dr. Patricia O’Campo

Every time we have a public conversation about violence at home, it makes the private conversations possible.

This is why we at MAP Centre for Urban Health Solutions at St. Michael’s Hospital, a site of Unity Health Toronto, were encouraged to see Wendy Gillis and Alyshah Hasham’s article outlining different ways to get support if home is not a safe place.

We would like to update this list with our recently launched WITHWomen suite of apps, available in English, French and Spanish. They can be found at https://maphealth.ca/with-apps/.

It is very hard to recognize the early signs of an unsafe relationship, but when women know their safety status and have access to local resources they are better equipped to take action.

These tools can help women assess safety, rank concerns, and support the creation of a tailored safety plan via connection with local resources across the GTHA. This technology is discreet and easy to use.

For example, the WITHWomen App asks nine questions that screen for a variety of unsafe behaviours. Most importantly, the apps are secure, private and web-based (no download necessary). These apps are available for use on phones, computers, tablets — anywhere you can use the internet. The apps include a quick exit function as a safety feature.

Intimate partner violence is enabled by shame and stigma. Our team created these apps so we can use technology as a tool to keep the conversation going.

L’application WITHWomen aide les femmes à évaluer leur niveau de sécurité

Courrier des lecteurs du Toronto Star, article rédigé par Patricia O’Campo

Chaque conversation publique sur la violence au foyer favorise les conversations privées.

Voilà pourquoi l’équipe du Centre MAP pour des solutions de santé urbaine de l’Hôpital St. Michael’s, un site de Unity Health Toronto, était ravie de lire l’article de Wendy Gillis et d’Alyshah Hasham décrivant différents moyens d’obtenir de l’aide pour les personnes qui ne sont pas en sécurité à la maison.

Nous aimerions ajouter à cette liste notre toute nouvelle série d’applications WITHWomen, disponible en français, en anglais et en espagnol. Ces applications se trouvent au https://maphealth.ca/with-apps/.

Il est très difficile de reconnaître les premiers signes d’une relation dangereuse, mais lorsque les femmes connaissent leur niveau de sécurité et ont accès à des ressources locales, elles sont mieux outillées pour agir.

Ces outils peuvent aider les femmes à évaluer leur niveau de sécurité, à classer leurs préoccupations et à créer un plan de sécurité personnalisé en les mettant en contact avec des ressources locales dans toute la RGTH. Cette technologie est discrète et facile à utiliser.

Par exemple, l’application WITHWomen pose neuf questions qui permettent de détecter divers comportements dangereux. Plus important encore, ce sont des applications sécurisées, privées et accessibles en ligne (aucun téléchargement n’est nécessaire). Elles peuvent être utilisées à partir d’un téléphone, d’un ordinateur, d’une tablette – partout où vous avez accès à Internet. Par souci de sécurité, les applications comprennent une fonction de sortie rapide.

La violence conjugale est alimentée par la honte et la stigmatisation. Notre équipe a créé ces applications pour nous permettre de poursuivre la conversation au moyen de la technologie.

From the Toronto Star

The number of people in Toronto who do not have a family doctor jumped significantly during the first two years of the pandemic, with at least 72,000 losing access to their physician, according to new data that underscores the worsening state of primary care in Ontario.

At least 415,000 Toronto residents lacked a family physician as of March 2022, instead turning to emergency departments and walk-in clinics for their health care.

And while there are residents across the city who don’t have access to a family physician, the latest findings from the INSPIRE Primary Health Care project reveal a pattern of inequity, including a higher proportion of residents with the lowest incomes lacking a doctor compared to those with high incomes.

The data shows that at least 120,700 residents with the lowest incomes don’t have regular access to a family physician, with neighbourhoods located in Toronto’s west end, areas north of the downtown and Scarborough most affected by the discrepancy.

“It’s incredibly concerning to see those who are living in the lowest income brackets are more likely to be without a family physician,” said Dr. Mekalai Kumanan, president of the Ontario College of Family Physicians (OCFP).

“We know that socioeconomic factors like access to food and safe housing drive health outcomes. And when you add to this a lack of access to a physician, this will absolutely negatively impact the health of those individuals.”

The new Toronto data mirrors provincial findings from INSPIRE released earlier this year that revealed more than 2.2 million Ontarians lacked a family doctor as of March 2022 — up from about 1.8 million in March 2020.

Health-care leaders, medical organizations and physician groups have been calling for further investments in primary care and warning that targeted reforms are needed to ensure every Canadian is connected to a family doctor or nurse practitioner.

They caution that a lack of access to primary care not only puts an individual’s health at risk, it also puts additional pressure on an already strained health-care system.

“We need bold reform to get us out of this crisis,” said Dr. Tara Kiran, who leads a national research project called OurCare that is gathering public input on how to reform primary care. According to recent OurCare figures, more than 6.5 million Canadians over the age of 18 — or more than one in five adults — do not have a family doctor or nurse practitioner.

This week, OurCare released a report authored by a panel of 35 “everyday Ontarians” who set out a suite of 23 recommendations to improve Ontario’s primary care system. The panel, randomly selected from more than 1,250 volunteers to represent the demographics of Ontario, with more weight given to equity-seeking groups, spent 39 hours learning about primary care and developing their recommendations.

Kiran, a family physician and scientist at St. Michael’s Hospital, a part of Unity Health Toronto, said the public’s voice has been missing from discussions in primary care reform and that these recommendations provide new directions for government and policymakers.

“These citizens together put forward a vision to change the system so it works for everyone,” she said, noting equity is “a foundational value” in the panel’s recommendations. “They’re thinking not just about themselves, but their families, their communities and the system.”

From CTV

Paper fentanyl test strips are a simple way for people struggling with substance use to determine if fentanyl has been mixed into their drugs, but some advocates say they fail to help the people most at risk of dying from an opioid overdose.

The tests are low-cost and easy to use. Working similarly to a COVID-19 rapid test, a user mixes a very small amount of the drug they want to test with water, and dips the paper test strip into the solution.

“Then you wait for the result so then on your little test strip,” Karen McDonald, head of Toronto’s Drug Checking Service, told CTV’s Your Morning on Tuesday. “One line will present if your drug is positive for fentanyl, two lines will present if your test is negative for fentanyl.”

However, McDonald – who has 15 years of public sector experience, including in health policy – said the tests aren’t beneficial to people who are addicted to opioids and knowingly taking fentanyl. Someone who has no intention of using opioids and detects the presence of fentanyl in their supply of a different drug would likely alter their consumption in response, she said, but these types of contamination cause the minority of opioid overdoses.

For people who intentionally use opioids, knowing their drugs contain fentanyl is a very small piece of the harm-reduction puzzle.

“For over five years now, fentanyl has really saturated the unregulated opioid supply and is really the opioid of choice for most folks using opioids at this point,” McDonald said. “So, simply knowing if there is fentanyl in their fentanyl doesn’t really add value for folks.”

From The Globe and Mail

The numbers of babies born with syphilis in Canada are rising at a far faster rate than recorded in the United States or Europe, an increase public health experts said is driven by increased methamphetamine use and lack of access to the public health system for Indigenous people.

While syphilis has made a global resurgence over the last five years, Canada is an outlier among wealthy nations in its rate of increase: 13-fold over five years, according to Health Canada. The incidence of babies born with syphilis reached 26 per 100,000 live births in 2021, the most recent year available, up from two in 2017, according to the Health Canada data.

That total is on track to increase further in 2022, according to the preliminary government data obtained by Reuters.

Babies with congenital syphilis are at higher risk of low birth weight, bone malformations and sensory difficulties, according to the World Health Organization.

Syphilis in pregnancy is the second-leading cause of stillbirth worldwide, the WHO said.

Yet congenital syphilis is easily preventable if an infected person gets access to penicillin during their pregnancy.

Among the G7 group of wealthier nations for which data is available, only the United States had a higher incidence of syphilis at birth: 74 per 100,000 live births in 2021, triple the rate in 2017, according to preliminary figures from the U.S. Centers for Disease Control and Prevention.

There were 2,677 cases of congenital syphilis in the U.S. in 2021 for a population of 332 million, according to preliminary CDC data. Canada had 96 cases for a population of 38 million, according to Health Canada.

People experiencing poverty, homelessness and drug use, and those with inadequate access to the health system, are more likely to contract syphilis through unsafe sex and pass it to their babies, public health researchers said.

“In high-income countries you see it in pockets of disadvantaged populations,” said Teodora Elvira Wi, who works in the WHO’s HIV, Hepatitis and sexually transmitted infection program.

“It’s a marker of inequality. It’s a marker of low-quality prenatal care.”

What sets Canada apart are its Indigenous populations who experience discrimination and often have poor access to health and social services, said Sean Rourke, a scientist with the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, who focuses on prevention of sexually transmitted disease.

“It’s just the whole system, and all the things that we’ve done in bad ways not to support Indigenous communities,” he said.

Health Canada told Reuters it has dispatched epidemiologists to help provinces contain the increase in congenital syphilis. Spokesperson Joshua Coke said the federal government is expanding testing and treatment access in Indigenous communities.

From the Toronto Star

Another aching death in Toronto’s transit system — this time, the killing of 16-year-old Gabriel Magalhaes — has renewed a sweeping question the city has faced for months. What do we do now to respond to the thrum of violence that’s shaken the city’s public transit system?

It’s an urgent issue made all the more difficult by the varied circumstances of the alleged perpetrators. While there are signs that at least some of the accused in recent TTC violence cases were struggling with their mental health, experts caution against drawing broad links between mental illness and crime. Similarly, though some of the accused had been living on the streets or in shelters, and homelessness has become increasingly visible on transit, health and social service workers warn against placing blame squarely on that population.　　

While experts have warned there is no single cause or simple solution, a consensus has emerged in recent months that suggests faults in the city’s social fabric — with an increasing number of people in desperate circumstances without adequate supports. It’s an assessment backed by Gabriel’s mother, Andrea, who has been outspoken in the days since her son’s death about cuts to social resources, and inadequate access to mental health care.

So, what can be done — in both the short and long term — to meaningfully turn things around? Here’s what seven health researchers and practitioners, criminologists and police leaders, social service workers and mental health advocates would like to see in Toronto’s future.

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The idea: A case-by-case deep dive to analyze what’s really happening

While Stephen Hwang, a physician and St. Michael’s Hospital Chair in Homelessness, Housing and Health, can list some general circumstances that can increase someone’s risk factors for violence, he sees Toronto as being in the throes of a condensed string of offences — one that should be examined in detail versus relying on assumptions.

To do that, he suggests a multidisciplinary “expert panel” explore the circumstances of each alleged perpetrator leading up to the moment of violence. (One challenge, he noted, would be protecting the rights of people who hadn’t yet faced trial.)

What did their life look like leading up to that day? Had they sought help in past for their mental health and hit roadblocks? Had they dealt with increased isolation in the last few years? Were there any warning signs or missed interventions, or did it come truly “out of the blue”?

“As a scientist, the first thing you need to do is look for patterns in the data,” Hwang said, cautioning that speculating or painting all the accused of the same brush is “unwise.”

In the short term, Hwang said consistency is important, questioning the effectiveness of increasing police presence in the TTC, only to publicly end that effort within weeks.

“If you know there’s never going to be a policeman there again, then the deterrent effect goes away.”

First in a series of Healthy Debate articles exploring the results of the OurCare survey.

Family medicine is the front door of the health-care system. But for too many people in Canada, that front door is now closed.

Results from the OurCare national survey estimate that more than one in five Canadian adults – 6.5 million people – do not have a family physician (FP) or nurse practitioner (NP) they can see regularly for care, a situation that has become worse during the COVID-19 pandemic.

The survey was conducted between September and October last year and includes more than 9,000 responses from across the country. It’s the first phase of OurCare, a national initiative to engage the public on the future of primary care in Canada.

We found that the situation is particularly bleak in some parts of the country. In British Columbia, Quebec and the Atlantic provinces, approximately 30 per cent – almost one in three adults – reported not having a family doctor or nurse practitioner. Contrast that to 13 per cent in Ontario.

And some groups are worse off than others. Fewer adults who were racialized, lower income and in poorer health reported having a family doctor or nurse practitioner.

Thirty-five per cent of those age 18 to 29 said they didn’t have a family doctor. Some young adults may not think they need one. Indeed, 17 per cent of respondents who were without a family doctor or nurse practitioner said they weren’t looking for one, most commonly because they thought they were healthy and didn’t need one. Yet, as family doctors, we know the importance of being connected to primary care early in people’s lives.

At first glance, the numbers don’t seem as bad for older adults. But it’s a huge concern that 13 per cent of those 65 and older reported not having a family doctor – everyone in that age group needs access to primary care.

Primary care – the type of care provided by family doctors and nurse practitioners – is foundational to any well-functioning health system. Family practices are the first place you should turn when you have a new health concern. They manage ongoing health conditions and provide care to keep you well in the first place. They are the entry point into the health-care system, coordinating the care you get from others, including specialists. Without it, patients are lost and left alone to navigate a complex system.

From CBC

Toronto showed “significant unfairness” when it cleared encampments in the summer of 2021 and chose to act quickly despite there being no urgency to do so, an investigation into the controversial moves has found.

In a report released Friday, Toronto Ombudsman Kwame Addo says the city chose “speed over people” when it forcefully cleared encampments in Trinity Bellwoods, Alexandra and Lamport Stadium parks.

“Our investigation found the City displayed insufficient regard for the people it moved out of the parks,” Addo said.

“It failed to live up to its stated commitments to fairness and a human rights-based approach to housing.”

Addo’s office launched an investigation in September 2021 following the encampment clearings which saw police officers in riot gear clear the sites of residents and their supporters, and resulted in dozens of people facing charges.

The investigation focused on how the city planned the encampment clearings, engaged stakeholders and communicated with the public. It found a number of problems, including that the city treated the clearings as a “top priority” and chose expediency and enforcement despite there being no evidence to suggest the encampments were an emergency requiring an urgent response.

Addo found the city chose to clear encampments quickly rather than focusing on the needs of those living in them. As well, it said the city was aware people living there had complex mental health needs, “yet failed to include plans to address those needs.

“Encampments and supporting the people living in them are complex. But the City owes a particularly high duty of fairness to these residents,” he said.

Longtime street nurse Cathy Crowe called Addo’s report a thorough one.

“It essentially demonstrates that homeless people were treated like an infestation … the efforts were to stomp them out and never have them come back, as fast as possible,” said Crowe.

“It tells the tale of malpractice that led to violence and injury.”

Report findings ‘validating’ for advocates

Addo also found that the city failed to foster meaningful engagement with people living in them, but rather communicated in a way that was “confusing, lacked transparency and showed a lack of understanding about their reality.” 

They also did not provide any dedicated onsite staff for people living in temporary dwellings in local parks to speak with, despite the city knowing they had questions which had gone unanswered, the report adds. 

In an interim report released last July, Addo concluded that city staff rely on an outdated and inconsistent approach when it comes to dealing with unhoused people in public parks.

“I think it’s validating for a lot of people who were doing advocacy around the encampments who were struggling to get the truth out,” said Zoë Dodd, a community scholar at MAP Centre for Urban Health Solutions.

“The one thing the ombudsman talks about is harm and trauma, but it wasn’t just harm and trauma, it also led to people’s deaths.” 

Recent city data shows Toronto saw an average of more than three deaths per week among people experiencing homelessness last year, totalling 187 deaths in 2022.

From the CBC article

Toronto updated its 14-month-old decriminalization request to the federal government Friday, clarifying it wants a Health Canada exemption to cover young people as well as adults, and all drugs for personal use.

The city’s submission, an update to its initial January 2022 request, indicates Toronto wants the federal agency to go further than the exemption it recently granted to British Columbia under the Controlled Drugs and Substances Act.

It makes clear the city wants its exemption to apply to all drugs for personal use and shield young people from criminalization, a departure from the B.C. exemption, which only applies to adults and lists a select number of substances. 

Medical Officer of Health Dr. Eileen de Villa says the submission sent to Health Canada, co-signed by the city’s police chief and city manager, is a “made-in-Toronto” model reflective of a months-long consultation process. 

“We’re talking about a matter of health and a matter of human rights, not one that really is meant to be addressed or is best addressed with a criminal justice approach,” she said in an interview. “That’s why we’re pursuing this route.” 

B.C.’s three-year exemption under the Act was granted in June and came into force Jan. 31. While that exemption caps possession at 2.5 grams, the Toronto submission does not outline a specific threshold for what constitutes personal use.

Pace of approval process has garnered criticism 

Drug use and purchasing patterns are “exceptionally diverse,” the submission said, and can vary based in part on a person’s tolerance. All trafficking and drug production would remain illegal.

Whereas the B.C. exemption only applies to people 18 and older, the Toronto model would also apply to young people. A 2019 survey conducted by the Canadian Association of Mental Health indicated around 11 per cent of Ontario students in Grades 7 to 12 reported the nonmedical use of opioids in the past year. 

Eight people aged 12 to 17 died from opioid overdoses in Toronto between 2019 to 2021, the submission said. 

“Health issues are health issues regardless of the person involved,” said de Villa. 

“That’s why we feel that this is something that does have to apply to all so that we’re sure that even the youngest members of our community are having their health issues looked at and addressed through a health lens rather than through something like a criminal justice lens.” 

The pace of the approval process has garnered criticism from drug users and advocates who say it fails to match the urgency required of an overdose crisis that has kills hundreds of people every year in Toronto. 

“They’re moving way too slowly. So, it’s nice to see movement. It’s just whenever you see a little bit of movement, I think, for me at least, it hits home just how slowly this process is going — how much we’re dragging our feet,” said Dan Werb, director of The Centre on Drug Policy Evaluation at St. Michael’s Hospital.

Decriminalization will not make the street supply any less toxic, Werb says, but it could reduce the barriers people face to accessing services that help prevent them from dying of overdoses.