Policy and Political Action

Policy & Political Action

Update on Toronto's Cold Weather Protocol (City of Toronto Board of Health)

Dear Councillor Mihevc and Members of the Board of Health,

This letter is to urge the City of Toronto to take robust action to prevent avoidable deaths of people who are homeless during cold weather. The Medical Officer of Health has recommended that the current criteria of an Environment Canada forecast temperature of -15 degrees C. or colder, or a wind chill of -20 degrees C. or colder, taking into account other weather conditions, be continued for issuing Extreme Cold Alerts. The Registered Nurses' Association of Ontario (RNAO) recommends that the City of Toronto and the province of Ontario safeguard the lives and health of people who are homeless by adopting similar criteria and approaches to those used by Public Health England.

It is estimated that on average there are about 25,000 excess winter deaths each year in England. Public Health England points out that "extreme cold can kill directly through hypothermia, however, this is rare." It is estimated that diseases of the circulatory system, including heart attacks and strokes, account for 40 per cent of excess winter deaths, and about one-third are due to respiratory illness. In order to "prevent avoidable harm to health" and "reduce pressure on the health and social care system during winter," the 2015 Cold Weather Plan for England includes year-round planning, winter preparedness, alerts, and action. Severe winter weather alerts are issued if there is a 60 per cent likelihood that the mean temperature will be 2 degrees C. or less for a period of at least 48 hours and/or widespread ice and heavy snow is predicted. Severe winter weather action occurs when the mean temperature is 2 degrees C. or less and/or widespread ice and heavy snow. Although action to protect health on the coldest days remains important, Public Health England has shifted emphasis to year-round planning and all-winter action to have the greatest impact. Evaluation of their 2012-2013 Cold Weather Plan found that "the negative health effects of cold temperatures start at relatively moderate outdoor temperatures of around 4-8 degrees C. (depending on region). Although the risk of death increases as temperatures fall, the higher frequency of days at moderate temperatures mean that the greatest health burden in absolute number of deaths, occurs at these moderate temperatures, during a normal winter."

In Toronto, we know that people experiencing homelessness make up a disproportionate proportion of emergency room visits at St. Michael's Hospital "highlighting their increased vulnerability to the effects of cold weather." The Medical Officer of Health's report cited emerging international, national, and provincial research that confirms an increased risk of death and adverse health impacts beginning at moderately cold temperatures. The conclusion, however, was "there is currently insufficient evidence to support making changes to the criteria used to issue an Extreme Cold Weather Alert."

RNAO respectfully disagrees with this conclusion given the evidence from Public Health England. The deaths of three homeless men outside in frigid Toronto on January 5, 2015, January 6, 2015, and January 13, 2015 suggest there are limitations to the current system. London, England and the greater Vancouver area have relatively warmer winter temperatures than Toronto and yet have lower thresholds to mobilize resources to prevent deaths of people who are homeless. The core criteria for 10 metro Vancouver communities with extreme weather response plans is the definition of extreme weather as "conditions deemed severe enough to present a substantial threat to the life/and or health of people who are homeless."

As a city and as a province, we can and must do all we can to protect the lives and health of people who are homeless.

Thank you for considering this feedback and we are pleased to answer any questions you have.


Tim Lenartowych RN, BScN, LLM
Director of Nursing and Health Policy
Registered Nurses’ Association of Ontario (RNAO)

See the full letter with references below.

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