Toronto’s top medical official is urging local hospitals to join an effort to track homeless deaths after her new report revealed 100 individuals experiencing homelessness died across the city last year.
Dr. Eileen De Villa said in the report that while the ongoing effort to collect homeless death data in Toronto is among the most comprehensive in the country, a lack of participation by hospitals makes it difficult to get accurate data.
“Homelessness remains a significant issue in Toronto, affecting some of the city’s most vulnerable residents,” said the report, based on the city’s first year of collecting death data. It added that barriers to hospitals reporting “relate to client privacy and confidentiality.”
De Villa is Toronto’s medical officer of health.
Toronto Public Health began tracking homeless deaths across the city on Jan. 1, 2017 following a Toronto Star investigation that found most municipalities in Ontario do not do it comprehensively, if at all. In previous years, the city had recorded only those deaths that occurred in city-run shelters; for 2016, that number was 33.
Now the city is working with more than 200 health and community agencies — but not hospitals — in an attempt to keep track of homeless deaths.
In her report, De Villa recommended she and the CEOs of the five Toronto-area Local Health Integration Networks (LHINs) now collaborate to determine how city hospitals could share data on homeless individuals who die under hospital care with Toronto Public Health.
She also recommended Toronto Public Health routinely share updated homeless death data with city planning staff.
Megan Primeau, a spokeswoman for the Toronto Central Local Health Integration Network, which oversees downtown Toronto hospitals and the care of more than 1.2 million residents, said the LHIN would look into whether hospitals could share information with Toronto Public Health under current privacy legislation.
“It would be within the mandate of the Toronto Central LHIN to help facilitate the necessary conversations to move on this important work forward,” she said.
The number of Toronto’s homeless dead officially tracked in 2017 is shocking and tragic. Of the 100 who perished — an average of almost two per week — 74 were male, 25 were female and one was transgender. Half of those who died were under the age of 48, with the youngest just 22. The oldest was 94 years old.
Most of the deaths, 65, happened indoors at places such as hospitals, infirmaries or shelters, mainly downtown; nine occurred outdoors while the locations of the remaining 26 are unknown. The way that the city learned of the hospital deaths in 2017 is likely because staff at a community agency or shelter reported to the city that some of their clients died in hospital.
The leading known causes of death were drug overdoses (27), cardiovascular disease (10) and cancer (9). There were 28 unknown causes of death, with three cases undetermined pending further investigation. The remaining 23 deaths covered a broad range of causes grouped as “other.”
“Although some of the leading causes of death, including cardiovascular disease and cancer, are common among the general population, the most striking feature of these data is the relative youth of the decedents,” the report states. “People experiencing homelessness in Toronto are living more than 30 years less than the overall population, on average.”
The report notes that even with attempts to improve the tracking system, some deaths will be missed.
Lauro Monteiro, executive director of Haven Toronto, a drop-in centre for homeless men over 50, called the report “incomplete” and one that seriously underestimates the death rate across the GTA.
“I don’t think 200 would be an unrealistic number at all, not in this city,” said Monteiro, noting that between 20 and 30 clients of Haven Toronto alone have died annually in recent years.
While Haven Toronto participated in the city’s initiative to track homeless deaths, Monteiro criticized the report for lacking key information, such as the location of death for 26 people.
“It’s harmful (because) incomplete information is not helpful,” he said. “There may be people out there who assume this is accurate, it’s gospel and they make public policy decisions on this.”
Councillor Joe Cressy (Ward 20, Trinity-Spadina) said the number of 2017 homeless deaths was “completely unacceptable.”
“Two people dying per week is a crisis, there’s nothing else you could call it, except perhaps an emergency,” said Cressy, stressing that the city needs to find a way to access data on homeless deaths collected by hospitals. “The importance of data is so that we can better respond to prevent these deaths.”