August 24, 1998

To:Urban Environment and Development Committee

From:Dr. Sheela V. Basrur, Medical Officer of Health

Subject:Health Impacts Related to the Cut-off of Vital Services

Purpose:

To address the possible health impacts to Toronto's residents should vital services be discontinued.

Recommendations:

(1)That this report be received for information; and

(2)that the City Solicitor be requested to review the feasibility and conditions under which the Health Protection and Promotion Act, c.H.7, R.S.O. 1990 could be applied in situations involving the discontinuation of vital services.

Background:

At the July 13, 1998 meeting of the Urban Environment and Development Committee, the Medical Officer of Health was requested to consult with agencies that serve tenants and persons living in poverty and to submit a report on the potential health impacts of refusing to intervene in the cut-off of vital services to the September 8, 1998 meeting of the committee.

Discussion:

Public Health staff invited representatives from agencies and organizations that serve tenants and persons living in poverty to a meeting on August 13, 1998 to discuss possible health impacts to residents should the city not intervene to restore cut-off vital services. Representatives from eight of the twelve agencies invited attended the meeting (see Appendix A for list of agencies).

The representatives expressed grave concerns for the health of tenants should the city not intervene when vital services are turned off. They identified health impacts to tenants, particularly "at risk" groups of individuals such as the immune compromised, newborn and the elderly. They discussed not only physical health impacts but also threats to the emotional and psychological health of the tenants that could put severe pressure on their ability to cope with daily demands and stresses. The group had further concerns that the loss of some vital services could impact on the ability of individuals to arrive at work on time or in an unacceptable hygienic state, which has lead in some cases to dismissal. This loss of work can have far reaching impacts on the individual or family setting.

The representatives felt the process as described through the Tenant Protection Act was insufficient to protect tenants during an emergency. It was their understanding the Provincial Tribunal that was being set up to respond to tenants complaints was not going to respond to emergency situations and issue immediate orders. Instead they are going to set up a hearing to hear both sides of a complaint and this process could take up to seven days before decision was reached. It was their position this was far too long for tenants to be without vital services. It was their opinion that the money necessary for the City to set up a process similar to the former City of Toronto's Urgent Hazard By-law was minimal compared to the taxes received from these same tenants. These representatives were advised to direct their concerns to this committee through letters and deputations.

When electricity is discontinued, lack of refrigeration can lead to food spoilage and food contamination with an increase in food poisonings. It could impact on the safety of baby foods and medicines also requiring refrigeration. Concerns were raised by the group that the poor would loose food due to spoilage in freezers and refrigerators and their all ready low nutritional status would be further compromised. Many individuals live week to week and the loss of all their food could be devastating. Loss of electric air-conditioning during extreme heat waves can lead to dehydration, heat stroke or death especially for the elderly, the young, those with pre-existing chronic illness, and those on certain medications, e.g. for mental illness. Concerns were also raised for the elderly and physically disabled should elevator services be unavailable.

With the loss of water and sewage disposal, there is an increased risk for person-to-person transmission of gastro-enteritis. Lack of drinking water can also lead to dehydration, a condition that can have serious negative impacts to the elderly, the young and those with chronic illnesses. Many would not have the funds to purchase bottled water.

When gas or oil is turned off the loss of heat, in extreme conditions, can lead to hypothermia, which places infants, seniors and those who are ill or on certain medications at the greatest health risk. Concern was raised also to the threat of carbon monoxide poisoning and fires as individuals attempt to heat their rooms through any means available. Deaths have occurred when propane barbecues and other outdoor heating appliances have been used indoors without proper ventilation or fires have been set in unsafe and improper locations.

It should be added that opinions vary as to the feasibility of using the Health Protection and Promotion Act, c.H.7, R.S.O. 1990 to reduce the potential health hazards associated with loss of vital services. The feasibility of using the Act in these circumstances, the conditions under which it would be applied and the actions that could be taken under the Act to reduce the potential health hazards described above, should be reviewed by the City Solicitor before a decision is made to proceed in this direction.

Conclusions:

The health of the residents of Toronto could be compromised if vital services are turned off. I have reviewed the August 24, 1998 report of the Commissioner, Urban Planning and Development Services to this Committee and support the idea of a working group to review anticipated service cut-offs before they occur. I also have concerns about the feasibility of using the Health Protection and Promotion Act as a remedy in these circumstances and recommend that its applicability be reviewed by the City Solicitor.

Contact Name:

Dave Harrison, Manager

Environmental Health Services

Telephone:392-7685

Fax:392-1482

Dr. Sheela V. Basrur

Medical Officer of Health

Appendix A

Agencies Notified of Focus Group Meeting

East Toronto Community Legal Services *

Shout Clinic *

Toronto Shelter, Housing and Support *

FMTA *

Kensington Bellwoods Community Legal Services *

West Scarborough Community Legal Services *

Parkdale Activity and Recreation Centre *

SA Max Meighen Centre *

Woodgreen

Dixon Hall

Federation of Metro Tenants

Fred Victor Mission

Centre for Equality

COTA

Alternative Housing Subcommittee

Coalition of Metro Housing Centres

* Agencies who attended the group meeting