In many Canadian communities, winter service planning for people experiencing homelessness is reactive, often constrained by cost considerations rather than evidence. Arbitrary temperature thresholds (most commonly -15°C in Ontario and -20°C in Alberta) or extreme weather alerts trigger a series of public health responses, including the opening of emergency warming spaces. However, research shows that most cold-related injuries occur at temperatures above -15°C (Zhang et al, 2019). Service providers, outreach workers and emergency department staff see the consequences of these policies firsthand, but policymakers require more than anecdotal evidence to justify change.

In this presentation, we share how research in Toronto about cold-related injuries and hospital visits to avoid cold exposure has been leveraged to drive policy change in Toronto’s winter service planning. Using health administrative data, these studies quantified the population-level burden of cold-related injuries among people experiencing homelessness (Richard et al, 2023) and revealed a 70% increase in emergency department visits attributable to cold exposure (Richard et al, 2023) the same year Toronto closed its COVID shelter hotels. Advocates and policy partners leveraged this and prior evidence to successfully push for lowering Toronto’s threshold for opening additional warming spaces (from -15°C to -5°C), expanding warming spaces and 24-hour respite, and prompting Toronto’s first declaration of a homelessness emergency in 20 years.  

Throughout this presentation, we discuss the power of administrative health data in driving policy change. By providing population-level evidence, service providers and policymakers can promote decision-making based on real health risks rather than arbitrary thresholds –setting a precedent for other cities to follow.