Item - 2014.HL32.3

The Board of Health, should City Council approve the transfer of responsibility for co-ordinating Toronto's cold weather alert and response program from Shelter, Support and Housing Administration to the Medical Officer of Health in time for the 2014-2015 cold weather season:

1.         Requested the Medical Officer of Health to assume responsibility for calling Extreme Cold Weather Alerts as of the 2014-2015 cold weather season when Environment Canada forecasts a temperature of -15 °C or colder, taking into account wind chill and other weather conditions.

2.         Requested the Medical Officer of Health to update the weather criteria for calling Extreme Cold Weather Alerts as appropriate based on current scientific evidence.

3.         Requested that the Medical Officer of Health to develop a comprehensive Cold Weather Plan in collaboration with the General Manager of Shelter, Support and Housing Administration and other City officials as appropriate to reduce health risks for City of Toronto populations.

6.         Forwarded the report (June 10, 2014) from the Medical Officer of Health and the General Manager, Shelter, Support and Housing Administration to Public Health Ontario, Environment Canada, Health Canada, the Director of the Environment and Energy Division, and Social Planning Toronto.

This report reviews the temperature thresholds for issuing an Extreme Cold Weather Alert and whether any changes to the protocol are required. It also reports the findings of program reviews of the Metro Hall Warming Centre pilot project and the Out of the Cold program, and updates City Council on previous Council direction to open all 172 flex beds to relieve occupancy pressure in the shelter system.

In cold weather, hypothermia, frostbite, and trenchfoot can arise relatively quickly among homeless populations as a result of direct exposure to cold, with severe consequences including death. Emerging research now shows that cold weather also likely increases overall deaths and hospitalizations in Toronto, mainly due to cardiovascular and respiratory causes. Those most at risk among the general population are the elderly and people with pre-existing health concerns.

To protect homeless populations, Shelter Support and Housing Administration (SSHA) co-ordinates a suite of winter services including respite services such as drop-in centres that provide temporary escape from the cold, outreach services to connect with individuals on the street and check on their condition, and additional shelter beds. Currently, SSHA calls Extreme Cold Weather Alerts when the temperature reaches -15 °C or colder, or when other extreme winter weather conditions or circumstances warrant it, such as a severe snow storm. During an Alert, SSHA scales up street outreach, transit token availability and shelter access.

A new Cold Weather Plan co-ordinated by Toronto Public Health (rather than SSHA), with the Medical Officer of Health responsible for calling Extreme Cold Weather Alerts, will enable the full range of health impacts known to be associated with cold weather to be addressed and offers an ideal opportunity to review and update the criteria for calling Alerts. This transition aligns with practise across much of Ontario, is consistent with the City's approach to calling heat alerts, and provides an opportunity to engage City and community partners in a co-ordinated approach to cold weather messaging and response. As part of this plan, SSHA will maintain a leadership role in providing services to homeless populations.

The Metro Hall Warming Centre pilot and the Out of the Cold program are low barrier/low threshold programs that serve people living in precarious housing and a segment of homeless people at risk of exposure to extreme cold weather including those who do not regularly access other homeless support programs or services.  These programs provide a valuable service and should be continued.

The activated flex beds removed flexibility from the shelter system to respond to sudden demand surges and compromised Shelter, Support and Housing Administration's ability to respond to such surges in a timely fashion.  Flex beds should be returned to their original purpose, as soon as permanent shelter beds can be introduced to the system.