Chronic Disease and Homelessness


Based on a 2011 study conducted by St. Michael’s Hospital, 85% of people experiencing homelessness have at least one chronic health condition and more than 50% also experience mental health challenges. We often speak of “hard to reach” communities yet, for many, it is the traditional programs and services that are not reachable. As a result, many high-risk individuals go undiagnosed and untreated. A critical component of our cross-organization strategy lies in grounding our work where, how and when it is most relevant for those who are most at-risk for a range of chronic diseases

This past year, the Diabetes Education Community Network of East Toronto (DECNET), offered diabetes programs and services at more than six community locations where people who are precariously housed/homeless congregate, many of whom are also impacted by mental health concerns and/or substance use. Locations included Heyworth House, Mustard Seed, 416 Community Centre for Women, Nellie’s Shelter for Women, Warden Woods Community Centre (Out of the Cold program) and Oakridge Community Recreation Centre. The 21 community workshops and talks reached more than 128 individuals from these at-risk communities.

DECNET health care providers and peers with lived experience go where people are living to facilitate engagement and to reduce barriers. Along with the Canadian Diabetes Risk Questionnaire (CANRISK), screening and diabetes education, access to nutritious food is a vital component of this work. For example, at Nellie’s Shelter a six-week series was held with Cantonese and Mandarin interpretation for 45 women accessing the HerShare program. During these diabetes prevention workshops, offered by our outreach worker and diabetes prevention peer leader, 45 CANRISK assessments were completed. Keeping services relevant to reflect current life circumstances and complexities, all of our outreach is provided on a drop-in basis using a harm reduction approach; this gives individuals the option to participate when, how and if they feel ready. Through our participation in the Homeless Connect Toronto event in October, 2018, an additional 123 individuals experiencing homelessness received some connection and information about our diabetes services.

Within the SRCHC clinical team, similar outreach initiatives took place. Regular drop-in foot care during Outreach Clinic hours, annual flu clinics in local shelters and ongoing primary care in partnership with the Red Door Family Shelter are a few examples of how this work happens. In terms of new initiatives, in the fall of 2018, Michael Garron Hospital received funding to reduce the burden of “winter surge” on emergency department visits. In addition to increasing the hospital’s capacity, funds were given to partner community agencies so that hospital use was avoided. SRCHC was provided funding so that nurse practitioners could work in east Toronto shelters and drop-ins and, over six weeks, was able to provide urgent episodic care to the New Hope Shelter and the Mustard Seed.

Innovation and knowledge transfer are also important aspects of SRCHC strategic planning across teams as we continue to support and enhance the health of equity-seeking groups. Engaging in research advancements is one strategy. In early 2019, team members participated in the Homelessness and Diabetes research project led by researchers at St. Michael’s Hospital. Discussions are ongoing around how to better understand our program approaches in order to influence, in meaningful and respectful ways, the health outcomes for this community.