City moves to improve data on homeless deaths

Toronto Public Health will partner with non-government agencies to track instances of death among Toronto’s homeless population

As of January 1, 2017, Toronto Public Health will collect data on the deaths of homeless people. Previously, only deaths that occurred in, or shortly after leaving city-funded shelters were tracked, which resulted in misleading statistics. Now, Toronto Public Health will collect data from nearly 200 agencies throughout the city dedicated to supporting the homeless.

A Toronto Star investigation published in February 2016 titled “Ontario’s uncounted homeless dead” outlined how the methods for monitoring homeless deaths in Toronto have evolved over the past few decades. Data collection ranged from volunteers in the mid-1980s, to official organizations like the Toronto Disaster Relief Committee and the Toronto Indigent Death Enquiry programs which began in the late 1990s, to the tracking of deaths in city-administered shelters as of 2007.

Toronto Star reporters found two major reasons to explain previous approaches. First, “[t]he coroner’s office … has no mandate to track all homeless deaths …,” and second, “hospitals and social agencies, such as homeless shelters, are not required to report all such deaths to any central provincial registry.”

The lack of a clear mandate and direction has hindered meaningful statistical understanding of the issue.

Dr. Stephen Hwang, Director of the Centre for Urban Health Solutions at St. Michael’s Hospital, and a leading researcher in the area of homelessness as a determinant of health, suggested that, “In order for a system like this to work, there needs to be a coordinating agency or body that has the authority and the mandate to collect the information.” Toronto Public Health certainly fits this description, but the agency will not assume this task without significant challenges.

Hwang cited the absence of a standard reporting system and issues of confidentiality as historical challenges to data collection. Healthcare providers cannot disclose information on the death of individuals without the consent of kin, which is difficult to obtain for many homeless individuals.

In terms of immediate effects of these recent changes, Dr. Hwang stated that “[these changes] will not have an immediate impact on the lives of people who are homeless, or deaths among the homeless, which is the primary goal, but [are] important as a first step, as we need to be measuring the dimensions of the problem to take appropriate action.”

Data from approximately 200 agencies on homeless deaths will provide information that can deepen understanding of instances of homeless deaths and facilitate the development of targeted responses.

When asked whether there was a specific event that pushed Toronto Public Health to make this change, Dr. Hwang replied, “An article in the Toronto Star [“Ontario’s uncounted homeless dead”] got attention in the general public and the media. This was when Toronto City Council members made the decision. But it’s important to note that this was something that has been discussed on and off for about 15 years.”

In order to reduce the incidence of homeless death, data needs to be collected over a long period of time, Dr. Hwang said.

“[A]ttention to homeless deaths is something that comes up in the winter time. But the truth is that homeless deaths occur throughout the year, and are not particularly concentrated in the winter. The challenge is to maintain commitment to data reporting to Toronto Public Health in the coming months and years. It’s like a census, where the value of data is in tracking over time, not just of tracking data for one year, and this will be the ongoing challenge.”

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