“Health is a political decision,” says Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario and a long-time health leader and social advocate. Grinspun knows better than most that heat amplifies health risks, particularly for the homeless and under-housed. “We have a public-health crisis, one that is created by ourselves as communities, as societies, as taxpayers,” she says. “In extreme heat, people need the basic human rights of water, health care, and shelter.”



Grinspun says hot weather should be taken as seriously as cold: heat and humidity, she explains, can exacerbate pre-existing health conditions, interact poorly with psychiatric medications, and lead to heat stroke. “Extreme heat kills people” who lack adequate shelter, she says.



Environment and Climate Change Canada predicts that, by the end of the century, southern Ontario could see up to 50 more days a year that hit at least 30 degrees. But climate change also provides what Grinspun calls a “tragic opportunity” to create more awareness of the challenges faced by vulnerable populations in extreme weather.



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As many Ontario communities suffer through their hottest days of the year, these opportunities are everywhere.



Since 1999, Toronto has been conducting annual reviews of its Hot Weather Response Framework. Councillor Joe Cressy, chair of the Board of Health, says that the city aims to be “proactive” in its response to heat, especially as it concerns the most vulnerable. Last summer, the city operated seven cooling centres that opened on days when there were extreme heat alerts. This year, that changed.



The city is now directing those in need of cool spaces to 300 locations that are available all summer long. Libraries, pools, private and non-profit organizations, and city facilities are plotted on an interactive online map meant to identify nearby locations.



On July 4, Cathy Crowe, a street nurse and the Ryerson Distinguished Visiting Practitioner, posted on Twitter, asking residents to try out the map.



More than 100 people responded. Many were directed to splash pads, which are for adults with children. Some were sent to libraries or community centres, which have limited hours. Others were given locations that were far away, gender-specific, or require payment. While these might suit some looking to beat the heat, for the homeless, “it’s a mess,” Crowe says. “It’s dangerous, and it makes the city look really bad.” On July 23, Crowe and other local health professionals and social advocates sent an open letter to the ombudsman outlining their concerns and calling on the city to reconsider the changes.



Tammy Robbinson, the city’s manager of media relations and issues management, told TVO.org via email that “the Staying Healthy in Hot Weather section of the City’s website has recently undergone substantive changes”: the map has been updated and now features “better search-ability and usability on all mobile devices.” Users can now narrow down facility types so that splash pads, for example, can be avoided, and, she added, “additional filters are being investigated.” But Crowe says that issues remain.



Crowe tried the map again on July 20. As she wrote in an email to TVO.org, “It sent me to a community centre with a note to call first (and it doesn’t open early), a wading pool in a park, the YMCA where as far as I know all you could do is sit there. There is no food or refreshments or even water bottles given out at any of these places.” Locations should have water, seating, shade, and food and make social-work and health professionals available, Crowe says, adding that the city should offer transit tokens or shuttle services, as it has done in the past.



Cressy is aware of the criticisms but says that the old system was “ad hoc” and that the new network of cooling locations will help a wider variety of people, including those with inadequate housing or no housing — and not just on extreme-heat days, but all summer long. He notes that, instead of just seven centres, only one of which was open 24/7, the most vulnerable will now be able to access numerous shelters and respite sites.



Advocates such as Crowe and Grinspun agree that the old system was far from perfect, but they don’t think the new one offers enough resources. Grinspun adds that “shelters are over capacity already — how are we going to make them cooling centres as well?”



Toronto isn’t the only community having these complicated discussions. Ottawa, for instance, also uses a summer-long approach to heat — local shelters, pre-existing programs, and locations such as libraries extend their services during heat-warning days. While Ottawa’s heat-response plan is less detailed than Toronto’s, the city, according to a recent discussion paper on creating climate resiliency, “is planning a more detailed assessment of climate-related health risks and vulnerable populations.”



Audrey Lusignan, a peer team leader for Ottawa Inner City Health who has lived street experience of her own, knows that hot weather presents extra challenges for the homeless, such as trench foot and the need to wash sweat-drenched clothing. It also brings extra challenges for shelters and services like the OICH, which, she says, “are digging into their reserves” during extreme weather. She’d like to see more support from the city, as well as “more drop-ins that are more accepting of our population. Stigma is a thing, and it’s real.”



Communities worldwide are looking at innovative and effective ways to respond in hot weather, says Tanya Gulliver-Garcia, a former member of Toronto’s Hot Weather Response Committee. In 2008, she piloted a risk-based heat registry for Toronto, intended to assess and track the most at-risk populations in the city. The pilot “met people where they’re at, which is a key component of harm reduction,” she says.

Robbinson also noted that Toronto has contracted the Fred Victor Centre, a social-service charity with locations across the city, to deploy an outreach team between May 15 and September 30, within four hours of an Environment and Climate Change Canada heat warning being issued. At least two staff and/or volunteers with lived experience “engage with people in areas around the 24-hour respite sites located along the Lake Shore Boulevard/King Street corridor” from 8 a.m. to 8 p.m., she wrote.



Protecting people from heat should also involve monitoring high-risk indoor spaces, says Gulliver-Garcia. Some cities require that multi-residential apartment buildings have a common “cool room.” Vancouver, for instance, trialed this option last year in non-market housing. But, ultimately, she’d like more communities to adopt bylaws compelling landlords to ensure a maximum heat level in their rental units. Mississauga added an “adequate heat” bylaw that requires landlords to keep units between 20 and 26 degrees year-round. (Toronto’s only temperature bylaw applies to sufficient heat.)



Sophie Guilbault, manager of partnership development at the Institute for Catastrophic Loss Reduction, a non-profit research institute, says that, while heat strategies should be informed by research, they also need to be region-specific: “Sometimes, you need to try it out and evaluate it.” Plans should generally, though, she says, involve a combination of preventative actions — for example, reducing the urban-heat-island effect through improved green space — and responsive ones, such as water distribution or communication with the most vulnerable.



Grinspun would like to see Toronto expand on its commitment to using libraries as cooling spaces by “opening up beautiful rooms in the libraries, well set up for homeless people to be able to come, to rest, to be together, to have programs that would be appealing to them, where they can have water and snacks.”



Those living on the streets, she adds, are “the daughters, sons, partners of somebody. And if they’re not, that’s even more reason to take care of them.”