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Message: Income makes it on to the City of Toronto agenda!

The Globe and Mail, Monday, January 22, 2001

HIV, TB rates troubling
  Economic polarization puts immigrants, low-income families at risk, report says
By Gay Abbate


A rise in the number of HIV infections among gay men is only one of the challenges facing the city's public health department this year, a report on the state of the city's health says.

The annual report, to be tabled by the Toronto Board of Health today, shows that in the first half of last year the number of HIV infections in men who have sex with other men rose 16 per cent.

This statistic reflects the overall trend across North America since 1997 when the number of cases of HIV, the precursor to AIDS, began to rise after years of steady decline.

In the report, Dr. Sheela Basrur, medical officer of health, also highlights Toronto's tuberculosis rate, which is three times higher than that of the rest of Canada. About 400 to 500 new cases are reported each year in Toronto, with public health officials screening and following up more than 3,000 contacts, the report states.

Although the majority of TB cases are new immigrants, other contributing factors include homelessness, poverty and HIV infections, all of which, the report notes, exist at higher rates in Toronto than elsewhere in Ontario.

"If we can stop these diseases in their tracks -- well a few pennies of prevention are worth dollars in cure," said Toronto Councillor Joe Mihevc, chairman of the Board of Health.

He said the increase in the number of HIV-infected gay men is a "cause for concern."

He attributes it to people becoming complacent after the AIDS scare of the early 1990s and no longer practising safe sex. "They're willing to take chances more," he said, adding that the advent of new drugs to treat AIDS has also contributed to the complacency.

In discussing TB, the report concludes that "continued vigilance and renewed efforts to combat this disease are clearly needed." Dr. Basrur could not be reached for comment.

Most of the report focuses on the impact of the growing economic disparity between the city's poor and its wealthy.

It states that Toronto is a "city at the crossroads." While it offers tremendous opportunities for prosperity and diversity, "the future also holds many challenges, as growing economic and social polarization threatens to erode the progress we have made."

Mr. Mihevc said that if this disparity continues, "we're putting whole populations at risk, including low-income families, children, new immigrants, refugees and the homeless."

"I think we should see the report as a bit of a wake-up call to address some of these underlying issue of economic disparity," he said.

"Public health is like the canary in the mine. It's starting to sing and it's saying 'Hey, there some warnings for the path ahead.' "

The report states that three years after amalgamation is a good time to take stock of public health issues and to look ahead.

What Dr. Basrur sees is a city in which its demographic profile will articulate the public health issues.

Toronto continues to receive about 36 per cent of all immigrants to Canada and 40 per cent of all refugee claimants. This challenges public health to provide services that are appropriate and specific to the diverse communities, she states.

But income trends have the greatest impact on public health services. Despite the strong economy, the report states that between 1995 and 1998 the number of children living in low-income families grew 7 per cent and the number of low-income seniors increased 22 per cent.

"The improved economy is obviously not benefiting everyone. Many new jobs simply do not pay enough to make ends meet; employment earnings have not kept pace with rising rents," the report states.

About 140,000 people turn to food programs each month across the greater Toronto area, up from 125,000 in 1999, Mr. Mihevc said.

Other statistics in the report are equally alarming. Between 1988 and 1998, the number of admissions to Toronto shelters increased by 75 per cent. Over the same period, the number of children in shelters increased by 120 per cent.

Toronto also has 69 per cent of the region's seniors, 78 per cent of the youth who live alone, and 62 per cent of the single-parent families.

"This is significant since these populations are generally at higher risk of poor health and therefore require intensive and targeted public health interventions," the report states.



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