Opportunity Area About the Mid-West Who is the population of focus? High needs neighbourhoods in the north west area of • Population (2011): 305,989 • # Neighbourhoods: 19 Keelesdale-Eglinton West, Caledonia the sub-region, specifically focusing on chronic • Bounded by: CNR – Fairbank, Weston-Pellam Park, Oakwood disease and pre-natal conditions Eglinton/St.Clair– Yonge St – Lake Village and Corso Italia-Davenport • In , chronic diseases are projected to account for 89% of all deaths • Population, age 20+ yrs: 52,795 • Vulnerable population groups such as low income, immigrants are at • Women, age 15-49 yrs : 17,485 higher risk of getting chronic disease • Highest proportion of children in Weston-Pellam • High prenatal hospitalizations may indicate lack of adequate Park (23.7%), Caledonia-Fairbank (22.6%) and prenatal care for mothers, and may result in babies with health Keelesdale-Eglinton West (22.4%) problems • High % receiving social assistance in Keelesdale- Eglinton West (15.5%) and Weston-Pellam Park (14.6%) Why This Opportunity Was Identified • High proportion of imimigrants in Keelesdale- Eglinton West (60.9%), Caledonia-Fairbank Remarkably high prevalence in 5 adjacent neighbourhoods across all (56.6%)and Weston-Pellam Park (51.9%). reported chronic disease measures: • Diabetes: 7,790 adults (higher among females in 3 of 5 neighbourhoods) • Asthma: 8,153 adults (higher among females) • High blood pressure: 15,040 (higher among females) • Prevalence of diabetes, asthma, high blood pressure and COPD is highest for seniors ages 65+ among the five neighbourhoods

• Prenatal: 880 hospitalizations for pre-natal conditions

Considerations

High rate of pre-natal conditions in these same neighbourhoods: Feedback from providers: • Tackling chronic disease including prenatal care will Age-adjusted average annual rate of hospitalizations for Prenatal require partnerships ranging from education and health 30.0 Conditions (2011-12) 25.8 26.2 promotion, to primary care, to community services, and

49yrs 23.7 25.0 21.6 22.5 hospitals – which is the true power of a Local 18.4 18.6 19.0 20.0 15.8 15.8 16.7 Collaborative. 13.6 13.7 13.7 14.4 15.1 15.0 12.3

women 15 - Central LHIN Rate: 17.1 • A lot of resources are in place or being planned in this 10.0 Rate of High Blood Pressure for population 20+, geography that we could immediately leverage from one 5.0 2014/15 integrated perspective – such as community hubs, 0.0 satellite FHTs, innovative community programs, and ‘model school initiatives’.

Rate Rate per 1,000 Rates of High Blood Pressure are particularly high in Keelesdale- Eglinton West, Caledonia-Fairbank, , Corso Italia- • Opportunity to also partner with colleagues in West Davenport and Weston-Pellam Park compared to the rest of the Mid- Toronto as these same issues are prevalent in adjacent West sub-region neighbourhoods in the West. Opportunity Area About the Mid-West Who is the population of focus? Significantly high increases in ED visit volumes for 5 • Population (2011): 305,989 • Population of Waterfront, Niagara and Bay Street • # Neighbourhoods: 19 Corridor: 83,730 neighbourhoods in the Mid-West sub-region • Persons living below low income measure (after-tax): • Bounded by: CNR – Waterfront: 17.1%, Niagara: 15.3%, Bay Street: 26.7% • Growth in TC LHIN ED volumes over the past 10 years exceeded the Eglington/St.Clair – Yonge St – • Percentage of total immigrants who are recent population growth and is related to downtown high growth areas, Lake Ontario immigrants (from 2006 to 2011): Waterfront: 24.2%, changing demographics, and high population growth in neighbouring Niagara: 14.8%, Bay Street Corridor: 28.9% (highest in Mid-West) areas. • This has implications for how the LHIN, City, Ministry can proactively • ED Visits all ages: Waterfront: 13,713 , Niagara: 6,863 , plan and fund for the impact of continuing growth in residential Bay Street Corridor: 5458 (higher in females than development on acute care services and patients. males) for all neighborhoods) • Low urgency ED visits, all ages: Waterfront: 3,695 (higher in males than females), Niagara: 1,901 (higher Why This Opportunity Was Identified in females than males), Bay Street Corridor: 1,441 (higher in males than females) Five neighbourhoods have experienced significantly high increases in ED visit • Low primary care continuity: Waterfront: 26.9%, volumes since FY 2010/11(highest for Waterfront, Niagara, and Bay Street Niagara: 29.2%, Bay Street Corridor: 23.6% Corridor): • Percentage of ED visits without a primary care provider: Percentage Change in ED Visit Volumes Waterfront: 20%, Niagara: 15.2%, Bay Street 20.5% from FY 2010/11 to FY 2014/15 • Ambulatory Care Sensitive Conditions: Waterfront: 106 (higher in females), Niagara: 47 (higher in males), Bay 60.0% 49.3% Street Corridor: 72 (higher in males) 50.0% 37.1% 40.0% • Hospitalizations: Waterfront: 3,128 (higher in females), 24.3%28.6% 30.0% 18.5% Niagara: 1,955 (higher in females), Bay Street Corridor: 20.0% Toronto Central LHIN Rate: 9.6% 10.0% 2,452 (higher in females). 0.0% % of total ED visits Considerations Feedback from providers: • Information points to much of what we are Waterfront, Niagara, and Bay Street Corridor also experienced the highest seeing as providers that go into these percentage change in population overall from 2006 to 2011: communities – we need to work together to 66.7 70 % change in population count 2006-2011, Both sexes establish an integrated view of what services 60 are and are not available in these high growth 44.3 50 neighbourhoods and figure out how to bring 40 32 26.2 30 services to the people that live there 20 • The Island community is a very unique

Percentage Toronto Central LHIN Rate: 5.6% 10 neighbourhood that is logistically difficult to 0 -10 service – coordinating our programming and services within that community could help create something that is effective and efficient Opportunity Area About the Mid-West Who is the population of focus? Little Portugal – High needs neighbourhood specifically • Population (2011): 305,989 • Population: total = (65+ yrs: ) focusing on high hospitalizations for Ambulatory Care 12,055 1,865 • # Neighbourhoods: 19 • Immigrant population: 43.4% Sensitive Conditions (ACSC) and high Acute Alternate Level • Bounded by: CNR – • Higher rate of people with no knowledge of of Care (ALC) Eglington/St.Clair – Yonge St – English or French (12.5%) • ACSCs: conditions in those aged 20-74yrs where appropriate Lake Ontario • High percentage seniors living alone (26.3%) ambulatory care may prevent/ reduce the need for hospitalization (asthma, diabetes, CHF, hypertension, angina, COPD, epilepsy) • Higher marginalization index (2.8) • ALC: A patient that does not require the intensity of resources/services provided in an acute care setting. Mainly seniors 65+, with specialized Preventable Hospitalizations for Ambulatory Care needs and supports. Lack of LTC and supportive housing capacity are Sensitive Conditions often sited as major factors. • # of ACSC hospitalizations, 20-74 yrs (2012/13 to 2013/14): 106 (higher among males) Why This Opportunity Was Identified • Prevalence of diseases: Diabetes: 1,284 adults, (higher among females). Hypertension: 2,524 Little Portugal has the highest rate of hospitalizations for ACSC for adults, (higher among females) 20-74 yrs: • High proportion with low primary care continuity: Annual rate of hospitalizations for Ambulatory Care Sensitive 21.6% 600.0 Conditions, 20-74 yrs (2012/13 and 2013/14) 556.7 Alternate Level of Care Days 348.6 400.0 294.2303.3309.9317.5 251.5259.9 265 268.3272.1289.4 207.3236.6237.5242.3 • # of acute ALC days, all ages (2011-2012): Toronto Central LHIN Rate: 284.4 200.0 104 13,585 (65+ yrs: 9,027) (higher among females) • Hosp. rate, all ages (2011-2012): 78.6 per 1,000 0.0 Rate per 100,000 Population 100,000 per Rate Considerations Feedback from providers:

Little Portugal also has the highest percentage of Acute ALC days for all ages: • Presents an opportunity to begin to look at Percent of acute hospital days that are ALC, All Ages (2011-12) how to leverage and provide supports to 20.0 16.9 17.1 18.2 18.2 15.3 16.0 strong social and ethnic seniors communities, 13.2 13.3 14.3 15.0 11.3 11.9 12.5 12.6 as a starting point that could be scaled across 9.7 10.3 10.7 10.0 6.2 Toronto Central LHIN Rate: 14.0% the LHIN – important given the significant 5.0 diversity in the Mid-West 0.0 • A number of outreach programs that already % % in Days ALC Hospital exist can be built upon, such as Outreach Nursing Programs and an operating Diabetes Bus Opportunity Area About the Mid-West Who is the population of focus?

Kensington-Chinatown – High needs neighbourhood • Population: 18,490 (ages 0-4 yrs: 570) • Population (2011): specifically focusing on high ED usage and high 305,989 • Highest rate of : marginalization • # Neighbourhoods: 19 • Bounded by: CNR – • persons living below low income measure (after- tax) (39.3%) • Socio-economic and cultural diversity pose specific challenges Eglington/St.Clair – Yonge St – for access to health care, utilization and health outcomes. Lake Ontario • people with no knowledge of English/French (17%) • Low urgency ED use can be due to lack of appropriate • visible minorities (in private households) (62.1%) resources, lack of access to timely primary care and lack of awareness regarding available health care options. • lone parent families with children (47.1%) • Top three languages spoken at home other than English: Cantonese, Mandarin, Chinese n.o.s Why This Opportunity Was Identified • 4 Homeless shelters (1 Youth, 1 Women and 2 Co- ed, Total beds: 246 beds) Kensington-Chinatown has the highest rate of low urgency ED visits • Kensington-Chinatown experienced high growth from for all ages. 2011 to 2015. Age-Standardized Rate of Low Urgency ED Visits, Ages 0+ in Mid-West • High ED visits for ages 0-4 yrs: 402 (higher in males Toronto (2014/15) than females) 160 114.5112.7 110.8109.2107.3105.8104.3103.9101.8 • ED visits for low urgency ages 0-4 yrs: (higher in 120 99.9 96.6 95.6 95.4 91.1 180 85.2 81.5 76.9 males than females) 80 Toronto Central LHIN Rate: 92.4 40 • High % Low Continuity Among Ages 19+ (Enrolled and Not Enrolled) (25.3%) Rate Per 1,000 Pop 1,000 Per Rate 0

Considerations Feedback from providers:

Also, Kensington-Chinatown has highest marginalization rate in Mid- West Toronto. • There is a strong opportunity to build on Ontario Marginalization Index, per Neighbourhood, 2006 locally tailored services such as immigration partnerships, indigenous support, and 4 3.4 3.5 2.6 2.6 2.6 2.6 2.8 2.8 2.8 Chinese community supports and outreach. 3 2.2 2.2 2.2 2.4 2.4 2.4 2.5 1.8 1.8 2 2 City of Toronto: 2.4 1.5 1 0.5 0 Opportunity Area About the Mid-West Who is the population of focus?

• Population aged 0-4 years: Mid-West - High rate of low urgency ED visits for children ages 0-4 in • Population (2011): 305,989 13,340 (Kensington-Chinatown: 570, Bay Street Corridor: 795, over half of Mid-West neighbourhoods • # Neighbourhoods: 19 Little Portugal: 450, Waterfront Communities-The Island: • Bounded by: CNR – 1,290) • Use of the ED for non-urgent conditions may lead to excessive Eglington/St.Clair – Yonge St – healthcare spending and weaker patient-primary care provider • Proportion of families with children that are headed by a Lake Ontario relationships lone parent in private households: 19% (Kensington- • Studies show that low caregiver health literacy is associated with Chinatown:47.1%, Bay Street Corridor:34.9%, Little higher pediatric emergency department use and non-urgent visits Portugal:36%, Waterfront Communities-The Island: • Availability of after-hours care and parents’ perceived advantage of 40.1%) a pediatric specialist hospital often result in higher non-urgent ED • Proportion of population living below the low income cut- visits off: 21% (Kensington-Chinatown:39.3%, Bay Street Corridor:26.7%, Little Portugal:18.7%, Waterfront Why This Opportunity Was Identified Communities-The Island: 17.1%) • Highest proportion of the population that do not have Mid-West Toronto has the second highest rate of low urgency ED visits per knowledge of either official language (i.e. English and 1,000 population that are for children ages 0-4 among the sub-regions: French): 7.0% (Kensington-Chinatown: 17%, Bay Street Corridor: 3%, Little Portugal:12.5%, Waterfront Rate of low urgency ED visits per 1,000 population, Communities-The Island:1.5%) Ages 0-4 (FY2014/15) • Highest proportion of total immigrants: 42% (Kensington- Chinatown: Bay Street Corridor: , Little 300.0 253.4 47.4%, 41.8% 240.3 Portugal:43.4%, Waterfront Communities-The Island: 250.0 186.0 200.0 24.2%) 120.9 124.3 150.0 • Low urgency ED Visits for ages 0-4: 3,231 (Kensington- 100.0 Toronto Central LHIN Rate: 173.3 Chinatown: 180, Bay Street Corridor: 245, Little 50.0 Portugal: , Waterfront Communities-The Island: 0.0 133 428) West Toronto Mid-West Mid-East • Low continuity of primary care(enrolled and non-

Rate per 1,000 Population per Rate Toronto Toronto enrolled): 22.7% (Kensington-Chinatown: 25.3%, Bay Street Corridor: 23.6%, Little Portugal:21.6, Waterfront Update map Communities-The Island: 26.9%) More than half of the neighbourhoods also have high rates of low urgency ED visits for children ages 0-4: legend • Sick Kids Hospital is located in Bay Street Corridor Low Urgency ED Visits for Ages 0-4 (2014/15) 350 Considerations 300 250 200 Toronto Central LHIN Rate: 173.3 150 100 Feedback from providers: 50 0 Rate of Low Urgency ED visits per 1,000 Population, Ages 0-4 , FY2014/15 • Potential opportunity to work closely with

Rate per 1,000 per Rate Population primary care as a priority area for attachment Majority of neighbourhoods in Mid-West Toronto have higher than Toronto Central LHIN rates of low urgency ED visits for ages 0-4 (173.3) Opportunity Area About the Mid-West Who is the population of focus? • Population (2011): 305,989 Adults Aged 20+: highest rates in Niagara, Little Residents in the Mid-West sub-region living with • # Neighbourhoods: 19 Portugal and University. mental health and addictions issues • Bounded by: CNR – Eglington/St.Clair – Yonge St – • In any given year, 1 in 5 Canadians experiences a mental health or • Population aged 20+ yrs: 260,715 (Niagara: Lake Ontario addiction problem. 19,340, Little Portugal: 10,420, University: 6,980) • Young people aged 15 to 24 are more likely to experience mental • Mid-West has the highest number of homeless illness and/or substance use disorders than any other age group. shelters in the LHIN (22) (most in Kensington- Other high risk groups include those with low income, homeless, Chinatown, Annex & Niagara). Total of 1,099 beds Indigenous populations. • CAMH Queen St West site is located in Niagara • Mental illness can cut 10 to 20 years from a person’s life expectancy and Russell St site is located in University • People with MHA primary care visits: 29,933 (Niagara: 1,967, Little Portugal: 1,233, University : Why This Opportunity Was Identified 684) (Higher in females than males) • MHA Hospitalizations: 4,032 (Higher among males Mid-West has the highest volume and second highest rate of Emergency Visits in 2 of 3 neighbourhoods) for Mental Health conditions among the sub-regions (all ages): Emergency Department Visits for MH by Sub-Region (FY2014/15), Transitional Aged Youth 16-25 yrs: highest rates in 15,000 40 Wychwood and Yonge-St.Clair. 33.7 30 • Population aged 16-25 yrs: 48,410 (Wychwood and 10,000 25.5 22.3 Yonge-St.Clair: 2,655) 19.6 20 Visits for MH MH for Visits • MHA ED Visits: (over 3 years) (Wychwood: , MHA 7,800 3,572 155 5,000 12.7 1,000 per Yonge-St.Clair:112) (Higher in males than females) 5,184 4,828 5,286 10 2,525

Number of ED Visits for for Visits ED of Number 0 0 Rate ofRate ED West Mid-West Mid-East North East Considerations Volume of Emergency Visits for MH Rate of Emergency Visits for MH Feedback from providers: Rates of Mental Health and Addictions ED visits for transitional aged youths (16-25 yrs) are higher than Toronto Central LHIN rate in several neighbourhoods:

yrs Average annual rate of ED visits that are MHA Visits, Ages 16-25 • Prevalence of mental health and addictions in

25 (2012-13 and 2014/15) 40.0 33.3 33.8 the core amongst transitional aged youth 35.0 27.6 27.8 28.0 28.1 28.4 28.9 29.4 29.8 provides an opportunity to partner with 30.0 26.0 26.3 21.7 22.3 23.5 23.9 25.0 19.2 colleges and universities as well as youth 16.8 Toronto Central LHIN Rate: 27.2 20.0 13.1 homeless shelters and programs to expand 1,000 Pop, 16 - 15.0 10.0 resources to youth in settings that are outside 5.0 of hospitals

Rate perRate 0.0 • Have a significant resource and strength in Rate of Hospitalizations for Mental Health Conditions per 100,000 having CAMH geographically located in the population aged 20+ (2012/13 -2013/14) Mid-West Opportunity Area About the Mid-West Who is the population of focus?

Homeless, under-housed, and street involved • Population (2011): 305,989 Limited information for the Mid-West: population in Mid-West sub-region • # Neighbourhoods: 19 • Mid-West has the highest number of homeless shelters in the LHIN (22) (most in Kensington- . • Bounded by: CNR – • Increasing number of individuals who are experiencing precarious Eglington/St.Clair – Yonge St – Chinatown, followed by Niagara and Annex). Total of housing, particularly women in shelters and seniors Lake Ontario 1,099 beds: • High use of health related services among homeless persons • 6 Men: 379 beds • Studies have shown a strong correlation between precarious • 4 Women: 220 beds housing and mental illness • 5 Co-Ed: 234 beds • People living in precarious housing have decreased access to • 5 Youth: 172 beds health resources; while those with access often experience • 2 Family: 94 beds marginalization But here’s what we do know about the homeless in Toronto and Toronto Central LHIN Why This Opportunity Was Identified • Approximately 5300 homeless individuals (2013) • Indigenous population representation: 16% (2013) Highest number of shelters in Toronto Central LHIN: • Seniors aged 61+: 10% (2013) (doubled from 2009) • Women: 33% (2013) (up 7% from 2006) Number of Shelters in Mid-West Toronto by Neighbourhood • Use of health related services in the last 6 months (2016) (2013): Kensington-Chinatown 4 • Health clinics: 43% Niagara 3 • Hospital/ED use: 46% Annex 3 • Ambulance: 26% Dovercourt--Junction 2 • Harm reduction supports: 15% Wychwood 2 • Detox: Waterfront Communities-The Island 2 13% University 2 Trinity-Bellwoods 1 • High rate of repeat ED visits for unknown LHIN Palmerston-Little Italy 1 (mainly homeless) compared to TC LHIN: MH: 44% Oakwood Village 1 vs 28%; substance use: 59% vs 45% in Q1 2015/16 Caledonia-Fairbank 1 • 59% (6,478) of individuals waiting for MHA supportive housing were homeless , March 2016 (all 0 1 2 3 4 5 LHINs) Highest proportion of those receiving community addictions treatment:: Location of Toronto Central LHIN Shelters Residence of People who Receive (2014) Community Addictions Treatment Considerations (2015/16) East, West, Feedback from providers: 15% As outlined, shelters are densely populated 28% • Strongly recommend one of the 5 sub-regions in the Mid-West Toronto sub-region looking at physical and mental health supports for Mid-East, 13% this population, with a specific intent of spreading and scaling successes – if not the Mid-West, then North, 7% Mid-West, likely the Mid-East, or perhaps even a partnership 36% between the two.