Cathy Crowe

 

 

 

Newsletter No. 27  September  2006

 

I've been a street nurse in Toronto for 17 years. In the spring of 2004 I received the Atkinson Economic Justice Award which permits me to pursue, for up to three years, my passions for nursing and working on homelessness and housing issues.  In this newsletter I hope to report on my activities, create a link to a broader group of individuals who care about these social issues and encourage critical debate.


Further information about subscribing to the newsletter is found below.  I want to hear from you - about the newsletter, about things that are happening in the homelessness sector (what a sad term!), and about good things which will provide inspiration for all of us.

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Disaster, Poverty and Neglect

1 . Killer Heat: A 2006 Post-mortem (hopefully my final word on the matter)
2. Displaced Persons: From New Orleans to Glace Bay
3. Disaster Relief Funds: The Feds Try Skipping Out On “Skippy” (SCPI)

 

1.  Killer Heat: A 2006 Post-mortem

 

Reported Deaths - 2006 Heat Waves

 

Chicago          37

New York        36

Baltimore        19

St. Louis          6

California        148

Toronto            0

 

 

I would like to believe that Toronto escaped the catastrophe of heat-related deaths this summer. I don’t. Not when:

 

  • Front-line workers reported several bodies removed from Toronto rooming houses during the heat waves.
      

  • The Coroner and Ontario’s Medical Officer of Health did not issue a directive to Ontario physicians requesting they notate the suspicion of heat as a co-factor on death certificates. 
      

  • There has been no research on 911 calls, patient transports, or emergency room usage during heat waves, despite a reported 14-26% increase in EMS calls on at least 4 heat wave days and a 14-22% increase in patient transports by EMS on those same days.
      

  • CBC television news reported that Toronto paramedics made at least two calls during a heat wave that were cardiac in nature and resulted in death, where the paramedics suspected heat was a factor.
      

  • The Toronto Coroner’s office initially reported to the Toronto Disaster Relief Committee (TDRC) that there was one heat-related death this summer and advised us they were investigating several other deaths related to the heat. However, after several media outlets made calls to the Coroner on this subject, the Coroner backtracked denying there were any heat-related deaths.

In 2005 TDRC and the Toronto Board of Health requested the Coroner consider holding an inquest into the death of Richard Howell, who died in his rooming house during a heat wave.  One year later, the Coroner advised both groups by phone that there would be no inquest as there was nothing to be learned.  Repeated requests by TDRC for the Coroner’s decision in writing have been refused.

 

How to prevent heat deaths and what our officials are NOT doing.

 

It’s no secret that most heat wave victims are elderly and poor.  Two primary reasons for death are a lack of air conditioning and the necessary family and agency supports that can prevent a medical emergency.  People with other types of conditions such as depression, diabetes and those on psychiatric drugs are also at higher risk of death during a heat wave.  Dr. Sari Kovats of the London School of Hygiene and Tropical Medicine argues in the British Medical Journal that the current response in the UK is still not adequate.  She believes that vulnerable people must be actively identified and protected.  Sociologist Eric Klinenberg writing about the 1995 Chicago heat wave that killed over 700 people noted: “Heat waves are special disasters because they pinpoint the poor.”

 

In the aftermath of previous heat related tragedies, most major cities in the United States and Europe implemented creative, common sense and practical measures to prevent heat-related injuries and death in vulnerable populations. These include the opening of neighbourhood-based cooling centres that provide sleeping opportunities and food, door-to-door and phone outreach to vulnerable populations, air-conditioning / fan and energy assistance programs, as well as major involvement by the Mayor’s offices in communication strategies.  I described these measures in more detail in my August newsletter.

 

In contrast, Canadian municipal, provincial and federal governments all seemed to be at the cottage.  Just about everyone I tried to contact on this issue in July and August was away.  Perhaps the most absurd example was Toronto’s Heat Emergency Committee, comprised of EMS , Red Cross and various City departments, who met once in July and scheduled their next meeting for October.

 

In Toronto to date, no research has been done to evaluate the impact of extreme heat on vulnerable populations.  To date, no work has occurred to modify the City by-law that states rooming house windows on higher floors cannot be opened more than 100 mm (3 inches).  To date, there has been no examination of 911 calls or emergency room utilization related to heat injury and death.  To date, the City has not planned a consultation with organizations that provide services to vulnerable populations such as the housebound, frail elderly, disabled or homeless people, to learn what their needs are and what prevention measures and programs could be implemented.

 

So what did happen in Canada during North America ’s 2006 heat wave? 

 

Windsor decided to cancel the opening of cooling centers. Hamilton decided to cancel the practice of calling heat alerts (note: this decision was quickly reversed after community outrage and opposition).

 

Toronto called several extreme heat alerts, but well into weekends, despite long-range forecasts of extreme heat during the previous workweek.  This left a skeleton social service system and a media grappling with how to get the word out to a vulnerable public, as City staff were unavailable to update their web site, issue a press release or even provide media interviews. 

 

Despite direction by City Council, Toronto bureaucrats were unable to find an accessible location to relocate its only 24-hour cooling centre, out of a public lobby in Metro Hall.  Toronto bureaucrats were also unable (or perhaps unwilling) to find a way to provide something more substantial than cereal bars for visitors to the cooling centre.  This prompted TDRC coordinator Tanya Gulliver and myself to deliver fresh, individually wrapped Tim Horton sandwiches and juice to the Metro Hall cooling centre.  In what can best be described as a Jon Stewart or a Second City comedy sketch, we were not allowed to distribute the food inside the cooling centre and instead, people suffering from the heat had to meet us outside, on the sidewalk in the heat, to accept the food.  This even left Metro Hall security guards shaking their heads in amazement.

 

When I contacted the Ontario government to raise the issue of regional inequalities in municipal heat plans, which I believe are putting the public at risk, I faced bureaucratic apathy, inexperience and bungling.  A call to Minister of Health George Smitherman’s office led to a call back by a ‘Client Service Rep’.  I explained to him that this was not a client service issue and I wanted the Minister and the Medical Officer of Health to be informed of my concerns.  I outlined my background and experience on this issue and identified myself as a Toronto Board of Health member.  When asked what my ultimate goal was I replied, “an emergency meeting within a week with appropriate Ministry staff.”  I never received a call back and days later when I called the Client Service Rep, I was told that he was away for a week and no one had been given ‘the file’ to handle.  I then called a senior manager in the Ministry, which led to a return call by a toxicology expert!  That call led to another call with another person and so on … you get the idea. 

 

Doris Grinspun, Executive Director of the Registered Nurses Association of Ontario raised similar concerns and she received prompt replies and promises of policy review.  However, the only provincial statement to the public so far has been a bland and non-news worthy media release by Ontario’s Medical Officer of Health Dr. Sheela Basrur warning the public that:

 

 extreme heat and humidity can pose a risk to everyone, young and old, but it is the very young, the elderly and the chronically ill who need special attention.” 

 

The advisory included the following:

 

  • drink plenty of water and natural fruit juices, even if you do not feel thirsty
  • stay in air conditioned environments if possible. If you don’t have air conditioning at home use publicly available facilities; including cooling centres, community centres, shopping malls and libraries
  • if you don’t have air conditioning, keep windows slightly open, and windows covered
  • try not to use your oven, and stay away from making heavy, hot meals

I was encouraged to see an August 1 letter from Dr. Basrur to Doris Grinspun, where she wrote: 

 

 that in light of current and future environmental conditions, the problems associated with extreme heat require further consideration.  As such, the Ministry has begun to review current programs and policies within the scope of the Mandatory Health Programs and Service Guidelines, to better determine the most effective way to approach issues such as this.

 

Heat island effect and mitigation strategies.

 

We need to look at long-term solutions, including what we can do to reduce global warming, pollution and the heat island effect.  Populations in cities are at greater risk during heat waves due to the increased density of concrete, high buildings and higher pollution levels.  In July 2005 Toronto City Council voted to prepare a ‘Heat Island Mitigation’ strategy that could mandate new roofs meet Energy Star requirements, that trees be planted to shade buildings and parking lots, and that energy conservation measures be targeted for low-income housing.  One year later it is not clear which City manager or department has taken carriage of this issue.  Councillor Paula Fletcher, co-chair of the Toronto Board of Health, has agreed to investigate.  (councillor_fletcher@toronto.ca)

 

Looking Ahead: pilot programmes for 2007.

 

With the exception of John Andras (Project Warmth, TDRC co-founder, past-president of Downtown Toronto Rotary Club), it’s been hard to rouse interest from landlords, business or social services in air-conditioning / fan pilot projects.  The obstacles appear to be environmental political correctness and increasing hydro costs.  Every single person who has objected to the feasibility of developing an air conditioner / fan programme for vulnerable people has done so for environmental reasons or cited prohibitive hydro costs.  Ironically, most of the people objecting work and live in air-conditioned settings.  

 

Broad scientific research has shown that the greatest life-saving measure in an extreme heat emergency is access to air conditioning.  Yes, it may raise hydro costs, but we are not talking about people who use cappuccino machines, food processors, hair dryers, computers, TV/VCR/DVD’s, or even an iron.  In some cases we are talking about people who don’t even have a fridge or a stove.  Poor and vulnerable populations tend not to be energy hogs. 

 

A/C is no longer a luxury in extreme heat, not when indoor temperatures can reach 35 degrees Celsius and higher – it is a health issue.  Let’s figure out ways to begin this work, through government or non-profit agencies.  We need some real leadership on hydro rebates and other measures that will help tenants and landlords and people living on the streets, all of us, survive the killer heat.

 

Hopefully, with well-known environmentalist Elizabeth May, who actually uses the term ‘killer heat’, elected as the Green Party’s national leader, we should start seeing this important health issue on the federal agenda.  For more information on Killer Heat go to www.tdrc.net

 

 

2. Displaced Persons: From New Orleans to Glace Bay

This month, in The Earth Policy Institute newsletter, Lester Brown wrote:

 

“Those of us who track the effects of global warming had assumed that the first flow of climate refugees would likely be in the South Pacific with the abandonment of Tuvalu or other low-lying islands.  We were wrong, the first massive movement of climate refugees has been that of people away from the Gulf Coast of the United States.”

 

Brown goes on to report that the New Orleans’ pre-Katrina population was 463,000 and in July 2006 it was only 214,000.  Less than half of the pre-Katrina population returned.  Numbers alone cannot capture what happened to the displaced people – their loss, their poverty, the upheaval for their families, and the disruption to their lives.

 

The other day, once again, I was reminded of the similarities between Katrina victims and Canadians who are homeless.  I came out of a store near the St. Lawrence Market and a homeless man in his 40’s cried out to me in a strong Cape Breton accent “please will you get me a ride to Glace Bay ?” 

 

In my early days as a Street Nurse in Toronto , I learned that people migrated to the big city from economically deprived communities.  In those days, many people from the Maritimes ended up at Sherbourne and Dundas , victims of a different yet similar disaster – a collapsed economy.  Regional poverty and neglect forced them to the big city - the same regional poverty and neglect that forced Hurricane Katrina victims away. 

 

Pre-Katrina, 30 per cent of the New Orleans population lived below the poverty line.  Canada’s National Council on Welfare recently reported staggering losses in welfare incomes across this country.  In New Brunswick a single person on welfare must survive on $3,247 per year, a lone parent with one child survives on $13,656.  These numbers suggest that Canadians will continue to be displaced from their homes.  Copies of the report are available at www.ncwcnbes.net

 

Katrina still has its scandals – empty trailers, delays, bungling of relief funds and rebuilding efforts, and nixed insurance claims.  So too, Canada has its dirty side in how we deal with the victims of our homelessness disaster.  Read on…

 

 

3. Disaster Relief Funds: The Feds Try Skipping Out On “Skippy” (SCPI)

Katrina hits.  Federal disaster relief funds are needed.  The Winnipeg flood hits. Federal disaster relief funds are needed.  The Canadian ice storm hits.  Federal disaster relief funds are needed.  It’s obvious. 

It was the ice storm that, in part, led to the formation of the Toronto Disaster Relief Committee in 1998 and the declaration that homelessness was a man-made national disaster.  TDRC’s declaration called for two things.  The first, federal disaster relief funds needed to flow to the inner cities across Canada to help agencies and municipalities provide life saving shelter, food and outreach programmes. The second, the1% solution and the return to a fully funded national housing programme. 

While we still wait for our national housing programme, disaster relief funds were realized in 1999 in the form of the Supporting Communities Partnership Initiatives (SCPI – pronounced ‘skippy’). (click here for more info)

 

This program provided much needed emergency funds for homeless services including shelters, food banks, soup kitchens, identification programmes and renovations.  The program has been on, what leading housing advocate Michael Shapcott calls, a ‘death-watch’ for almost 18 months. It was due to die last year but was extended until March 2007. 

 

In August 2006 a disaster of its own played out across the country.  SCPI funding fell short, cheques ranging from $367,000 (London) to $1,000,000 (Ottawa) to $5,890,000 (Toronto) did not arrive and municipalities were told by government officials they would have to make do with less.  Promised funds were essentially missing.

 

In response to a major mobilization by community groups and municipalities across the country, Minister of Human Resources and Social Development Diane Finlay was forced to correct any ‘misunderstanding’ and promised the funds would be released to the end of the 2006 fiscal year, March 31, 2007.

 

The Disaster Relief Funds (SCPI) have not been able to correct the wrongs of the federal government’s cancellation of our national housing programme in 1993, but it is obvious that these disaster relief funds need to continue. 

 

The program is still slated to end in March 2007.  September 12th is a National Day of Action to save the Homeless Funds.  Go to www.tdrc.net to see what you can do to help.

 

“Urgency

State of emergency

Shows somebody’s government

Is far from reality…..”  

Chuck D singing “Hell No We Ain’t Alright”

 

 

Cathy


 

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