The Toronto Report Card on Housing and Homelessness 2003, reports that the number of homeless persons in Toronto continues to rise as a result of Toronto’s affordable housing crisis.The City and its community partners provide about 4,200 emergency shelter beds in 65 locations throughout Toronto, including five City-operated shelters. The number of men and women needing emergency shelter is at the highest level in 10 years. In 2002, a total of 31,985 different people stayed in an emergency shelter in Toronto, which is an increase of 21% since 1990.
The relationship between poverty, homelessness, and TB is well identified. Persons who are homeless or underhoused are more likely to be exposed to TB because the incidence of the disease is higher in the crowded settings which provide refuge and care for homeless people. Information gathered during the TB Shelter Pilot conducted in 1996, demonstrated that 30–40% of persons who use Toronto shelters or drop-ins are infected with latent TB. By comparison, the expected prevalence of latent TB infection in the general population is 5–10%(1).
Each year there are an average of 10 to 15 cases of TB reported in people who live in shelters or rooming houses in the City of Toronto. If we consider Toronto’s homeless/underhoused population to be about 25,000 this figure represents a rate of 40 – 60/100,000 which is triple or quadruple the rate of TB in Toronto as a whole.
While the number of cases is not large, these cases represent a substantial public health risk because they may expose large numbers of other people to infection. Those who are exposed are at increased risk of developing active TB as their immune systems may be impaired by other health conditions (such as poor nutrition, stress, fatigue and exposure to the elements) and, many homeless people have no access to, or have difficulty in accessing health care thus making follow-up and treatment for this population very difficult.