When Inna Berditchevskaia began her internal medicine residency in Hamilton two years ago, she was stunned that nobody could tell her how many people were dying while homeless in the city each year.
In Toronto, where she attended medical school, the numbers are collected and routinely published by the city’s public health agency, and she assumed this was standard. She now knows it is the exception.
“This is a population that there are a lot of services directed toward,” Dr. Berditchevskaia said. “If we don’t have data, how do we know where to direct the services to prevent morbidity and mortality?”
Anti-poverty advocates and front-line workers across the country have long called on governments to track the lethality of homelessness. But, despite years of intersecting housing and overdose crises, Toronto and British Columbia are the only places formally collecting this type of information. In both jurisdictions, the numbers have been increasing sharply.
In a few cities, the death toll is being estimated through a patchwork of grassroots efforts and memorials. But in the vast majority of the country, there is no tracking at all. As a result, no national statistics exist.
“It’s safe to say that it’s likely hundreds, if not thousands of people who have died across the country just this past year alone,” Toronto community and crisis worker Diana Chan McNally told a recent conference held by the Canadian Alliance to End Homelessness. “But it’s also telling that none of us – the experts – knows the mortal extent of this national crisis we are here to study and solve.”
In Hamilton, Dr. Berditchevskaia and a small team of colleagues have decided to do it themselves.
Through partnerships with local shelters and hospitals, they launched a community data project last year. Between June, 2021, and May, 2022, they identified at least 29 people who died while homeless in the mid-sized city.
Their average age at death was 38 years old, which Dr. Berditchevskaia noted stands in “absolutely appalling” contrast to the city’s average life expectancy of 81 years.
The locations of the deaths were split fairly evenly between hospitals (33 per cent), shelters (30 per cent) and the streets (29 per cent). The most common cause of death was overdose.
The people working on the data collection project try to determine the races and genders of the deceased, and any comorbidities they had, such as illnesses or substance use disorders. And the group also tries to determine whether each person, in the last 30 days before their death, had been evicted from an apartment, released from jail or treated in an emergency department.
Gessie Stearns, a social worker and member of the project team, said these circumstances are crucial factors in the deaths.
“Each number is an actual human being,” she said. “People are dying because of our laws and the ways we do things.”
The team acknowledges their data are incomplete. They are still awaiting access to information from the local coroner’s office.
“We know we’re missing people,” said family physician Claire Bodkin, who leads the project with Dr. Berditchevskaia. “But we do feel really strongly, as a research team, that doing something and starting from somewhere is important.”
Tim Richter, executive director of the Canadian Alliance to End Homelessness, said a lack of data makes it impossible to hold governments accountable.
“These people are living invisibly and dying invisibly,” he said. “We can’t solve a problem we can’t see.”
In Ontario, the provincial coroner’s office explained that the housing status of the dead would be a complicated thing to measure.
“Individuals may be within the shelter or social services system, or may be connected to a residence without actually residing at the residence, they may have living arrangements with friends,” spokesperson Stephanie Rea said in an e-mail. “Someone may die in an outdoor setting and not be experiencing homelessness. Further, if someone dies in hospital of natural causes, a coroner may not be called in to investigate the death.”
Toronto began tracking homelessness mortality in 2017, following an investigation by the Toronto Star into a spike in the number of deaths. The city recorded 221 last year, up from 144 in 2020, and 128 the year before that. So far this year, at least 92 people have died while homeless in the city.
The BC Coroners Service tracks these deaths when they meet the office’s reporting criteria, which cover fatalities in institutions, in police custody and from unnatural or unexpected causes such as drug overdoses or murders. But the service acknowledges that the data are incomplete. For example, a person who is homeless and dies in hospital of a heart attack would not be counted, because deaths from illness where the deceased were under the care of physicians are usually not reported.
“Homelessness itself isn’t a criterion for reporting or investigating a death,” said Ryan Panton, a spokesperson for the service.
The most recent report from the BC Coroners Service on homeless deaths in the province said there were at least 247 last year, up from 141 the previous year and 129 the year before that. In Toronto and B.C., as in Hamilton, the most common cause of death is overdose.
Anti-poverty activists have been setting up memorials across the country as tributes to the lives quietly lost.
One of them is in Edmonton, where the Coalition on Housing and Homelessness, an advocacy group, keeps an informal count of people who died while homeless. The group’s memorial ceremony this summer commemorated 222 people who died in the city last year, up from 132 in 2020 and 99 in 2019. In London, Ont., a similar coalition tracked 57 deaths between October, 2021, and October, 2022.
At the Hub, a drop-in centre in downtown Hamilton for people experiencing homelessness, there are dozens of names painted on a wall. They are a reminder of the many clients of the centre who have died in the past two years.
“Those are just folks that we knew personally here in the space,” Hub executive director Jen Bonner said. “That doesn’t include everybody. I’ve got seven more names to add since August 31.”
She said she is grateful that these deaths are being formally documented by Dr. Berditchevskaia and Dr. Bodkin’s team.
Dr. Bodkin argues it is negligent not to document the death toll of homelessness.
“If we don’t care that people who are homeless are dying – and any evidence that we do have suggests that they’re dying at a much younger age – then what are our values as a society?” she said. “What are the values in the people we elect, that … nobody knows, and nobody cares to know? It’s terrible.”