Health and Wellness

collage-healthWhy is this important?

Good physical and mental health are vitally linked to, and affected by, virtually all the issues raised in the Toronto’s Vital Signs Report. Adequate income, stable and appropriate housing, a safe and walkable neighbourhood, strong social networks, and a high level of education all enhance the health of Torontonians. The absence of some or all of those factors contributes to the likelihood of a city resident experiencing, for example, diabetes, depression, or obesity.

 

What are the trends?

The percentage of Toronto residents reporting good health remains relatively stable, but it isn’t improving (4 in 10 don’t report good health). Diabetes rates continue to be a major concern, and half of adult Torontonians now report being overweight or obese. The level of youth inactivity is troubling (and likely even worse than the data show, because the figures are self-reported and therefore generally under-reported). And while most Torontonians are satisfied with life and believe their mental health is good, almost a quarter of the population experiences high levels of stress.

 

Some Key Health and Wellness Trends
Data refer to the city of Toronto unless otherwise noted.
2012 2013 2014
1. Percentage (12 and older) reporting good or excellent health 59.5% 58.8% 58.2%[1]
2. Percentage (12 and older) reporting being diagnosed with diabetes 6.0% 6.2% 7.0%[2]
3. Percentage of Torontonians (12 and older) reporting being at least moderately active during leisure time 46.2% 52.6% 46.1%[3]
4. Percentage (18 years old and older) who report being overweight or obese 43.8% 46.2% 50.7%.[4]
5. Percentage who report very good or excellent mental health 69.3% 67.4% 70.5%[5]

 

What’s new?

A new Toronto Public Health report has analysed, for the first time, how the relationship between income and health in Toronto has changed over time. Low-income groups had worse health on a majority of indicators when compared with high-income groups. Meanwhile, a comprehensive snapshot of the wellbeing of the city’s youth has shown troubling inequities based on gender, ethno-cultural identity, socio-economic access, and sexual orientation. And a new study from Ryerson University explores the positive effects on children’s physical health of being given freedom to explore places within their neighbourhoods without adult supervision.

 

What are some of the biggest health challenges we face?

 

Although the majority of Torontonians report very good or excellent physical health in 2014, many are making some unhealthy lifestyle choices, and diabetes and obesity rates are growing alarmingly:

  • Almost six in 10 (58.2%) Toronto residents aged 12 and over say they are in very good or excellent physical health, and 66.8% of youth (aged 12 to 19) say the same.[6]
  • Nonetheless, although there were approximately 4.3 million visits to more than 5,700 City drop-in recreation programs in 2014,[7] less than half (46.1%) of Torontonians 12 and over report being at least moderately active during their leisure time (down from a high of 52.6% in 2013).[8]
    • And although there were more than 406,300 children and youth registrations in City recreation programs in 2014,[9] the percentage of youth (12-19) who are active during their leisure time is down seven percentage points from 2003 (from 67.2% to 60.2% in 2014) and lower than the national (70.4%) and provincial (68.0%) averages.[10] (It should also be noted that Statistics Canada research shows that children’s self-reported activity levels tend to be over-estimated.)
    • 14.5% of the population is limited in activity by pain or discomfort.[11]
  • 14.0% of Torontonians 12 and over reported heavy drinking (for men, that means having five or more drinks, and for women four or more, on one occasion, at least once a month in the previous year).[12] The rate represents a 22.8% increase since 2003 (from 11.4%), although it is lower than both the national (17.9%) and provincial (16.2%) averages.[13]
  • While the percentage of smokers has decreased from 19.9% in 2003, 15.6% of Torontonians still smoke (compared to 18.1% of Canadians and 17.4% of Ontarians).[14]
  • Only 38.3% of Torontonians 12 and over reported eating at least five servings of fruit and vegetables daily (down from 39.7% in 2013 and 42.5% in 2012).[15] Even fewer youth ate the required servings daily—just 36.8%, down from 40.8% in 2013 and 45.9% in 2012.[16]
  • Influenza immunization rates have risen 2.1 percentage points since 2003 (reaching their highest at 42.6% in 2005), but only 35.7% of Toronto’s population 12 and over were immunized against influenza in 2014 (similar to the provincial average of 35.4% but higher than the national average of 32.5%).[17]
  • Half (50.7%) of Toronto adults (18 years and older) report being overweight or obese, up from 43.8% in 2012 and 46.2% in 2013.[18]
    • The rate of adult obesity (self-reported body mass index of 30.0 or higher) increased 32.2% between 2003 and 2014, from 11.8% to 15.6% (although Toronto’s rate remains below the national and provincial averages of 20.2% and 20.4% respectively).[19]
  • Youth (ages 12 to 17) obesity is a greater problem in Toronto than it is nationally and provincially. Toronto’s rate was 27.0% in 2014, having risen 7.5 percentage points since 2005 (when data were first collected) from 19.5% (national and provincial averages were 23.1% and 23.3% respectively in 2014).[20]
  • Diabetes rates have increased by almost 43.0% since 2003. In 2014, 7.0% of Toronto’s population (aged 12 and older) had been diagnosed with the disease, up from 4.9% in 2003. Toronto’s diabetes rate is higher than the national average (6.7%) but lower than the provincial average (7.4%).[21]

In the Toronto Central LHIN (Local Health Integration Network) unit, which serves most of the city of Toronto, or approximately 1.15 million Torontonians, for every 100,000 residents, there is more than double the number of physicians than there are nationally and provincially:

  • The number of family physicians per 100,000 residents increased by 20.8% between 2002 and 2013, reaching 174 (up from 144). Comparatively, there are 111 physicians per 100,000 nationally, and only 103 provincially.[22]
  • There were 317 specialists per 100,000 residents in 2013 (an increase of 14% from 278 in 2002). In Ontario as a whole there were 106 specialists per 100,000.[23]
  • Nonetheless, 10.8% of this population was without a regular medical doctor in 2014, above the provincial rate of 7.5% (although lower than the 12.2% of 2005).[24]

snapshot

 

According to Wellbeing Toronto, in 2011 the Annex had the most health providers (doctor and dentist offices, pharmacies, and clinics) with 198, and Elms-Old Rexdale had the least with just one.

 


 

Most Torontonians are satisfied with life and believe their mental health is good. But numbers are decreasing over time, and almost a quarter of the population experiences high levels of stress:

  • Almost nine in 10 Torontonians aged 12 and over (88.7%) self-reported in 2014 that they are satisfied or very satisfied with life.[25] This is lower than the national (92.2%) and provincial (91.2%) averages, and not much higher than a decade ago (it was 87.8% in 2003).[26]
  • Seven in 10 (70.5%) said they are in very good or excellent mental health.
    • Over time, however, Torontonians’ self-reported mental health has decreased, by 1.2 percentage points between 2003 and 2014. It was at its highest in 2008 at 77.5% and lowest in 2013 at 67.4%.
    • Self-reported very good to excellent mental health in Toronto is currently lower than the national average (71.1%) and lower than the provincial average (70.4%).[27]
    • Nonetheless, only 7.3% report fair or poor mental health.[28]
  • The mental health of Toronto’s youth (12-19) has also declined. 70.9% perceived their mental health as being very good or excellent in 2014, a decrease of 6.4 percentage points since 2003 and lower than the national (73.9%) and provincial (72.3%) averages.[29]
  • 22.8% of the population (15 years and over) reported in 2014 that most days in their life were quite a bit or extremely stressful, down from 27.4% in 2013 but above the rate provincially (22.3%).[30] The rate is, however, slightly lower than the national rate (23%).[31]

 

 

What do we know about suicide rates in Toronto and what are we doing about it?

 

One of the most important yet least talked about population health issues—suicide—is being tackled by Toronto Public Health:

  • A review of available evidence on suicide in Toronto found that it is a growing cause of premature death.
  • 6% of Torontonians—over 150,000—have self-reported that they have considered suicide in their lifetime.
  • In 2009, suicide was the 17th leading cause of death in the city. There were 243 suicide deaths that year, more than four times the number of homicide deaths, and three times the number of motor vehicle crash deaths.[32]
  • In 2013, that rate increased as 262 Torontonians took their own lives that year.[33]
health-top20

Top 20 Leading Causes of Death, Toronto, 2009[34]

  • About 25% of those who took their own lives in 2009 had attempted suicide previously, and the majority (83% of the females and 73% of the males) had an identified history of mental illness.
  • Age-specific mortality rates from 2005-2009 show higher rates of suicide for males than females at all ages (although the difference is not significant at 10-19 years).
    • At 80 years and older, the suicide rate for males is more than four times higher than for females. The report authors are unsure, however, whether this is a true difference or whether female suicides in this age group are misidentified as dying from some other cause.[35]

 


 

health-agespecific
Age-Specific Mortality Rates from Suicide per 100,000 Population by Sex, Toronto, 2005-2009 (Combined)[36]

 

 

  • After undertaking a review of suicide prevention strategies from jurisdictions across Canada and worldwide along with a scan of multiple national, provincial, and community prevention policies, Toronto Public Health has identified gaps and opportunities for prevention initiatives in Toronto.
  • Current and emerging initiatives and services in Toronto related to suicide prevention include:
    • mental health promotion, suicide prevention policies and interventions, and a call for the City to address suicide prevention in “priority populations” including older adults;
    • 24-hour crisis services—integral to suicide prevention, intervention, and post- intervention—ranging from hospital-based to community-based services;
    • bridge barriers such as the Luminous Veil on the Prince Edward Viaduct System (Bloor Viaduct), which has successfully prevented suicides at the site since its installation in 2003;
    • reporting guidelines for media from the Canadian Association for Suicide Prevention to discourage copycat suicides (which research has linked to “public presentation of suicide”); they recommend including resources for getting help and warning signs of suicide while avoiding the disclosure of specific details; and
    • the Registered Nurses Association of Ontario’s “Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour” best practice guidelines.[37]

 

In 2014, suicide attempts on Toronto’s subway system reached their highest level since 2000:

  • As Council debated spending over $1B on platform edge doors (PEDs) to prevent suicide attempts and deaths on the subway system, the Toronto Transit Commission (TTC) released disquieting 2014 suicide statistics.
    • 30 suicide attempts were made in 2014 (almost double the 17 in 2013 and more than the annual average of 23.4). One-third were fatal.
  • globalPEDs have been proven effective at deterring suicides in Hong Kong, Singapore, and Paris. They also prevent delays from debris on subway tracks and allow for more efficient passenger boarding. They are however, expensive and would require the TTC to convert to automatic train control.
    • The cost of erecting PEDs has been estimated at $551M on the Yonge-University-Spadina line and $614M on the Bloor-Danforth line.
    • Trains need to align perfectly with PEDs, requiring control by computers rather than human drivers. The TTC has already begun converting the Yonge-University-Spadina line to automatic control, but it will still be another several years before PEDs could be in use.
  • Council voted 35-4 to request that the TTC consider PEDs in the design of new extensions or lines and retrofit existing stations with them.
  • Ideas-and-InnovationsIn the meantime, the TTC has measures in place to help prevent suicide attempts including the Crisis Link program, which connects people with a Distress Centre counsellor via a direct-dial button on a payphone on the platform, and a Gatekeeper program, which trains employees to notice and report suicidal behaviour.[38] The Crisis Link program received 218 calls between its introduction in June 2011 and June 2013.[39]

 

How can we improve outcomes for women experiencing intimate partner violence?

 

The Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital in Toronto is calling on policy makers, researchers, and healthcare administrators to make intimate partner violence screening a public health priority:

  • Intimate partner violence (IPV) is pervasive. The Department of Justice has estimated its cost nationally (in healthcare and other related costs) at $7.4B annually.
  • Healthcare settings provide a great avenue for screening women for IPV, but a Toronto-based CRICH study involving interviews with healthcare providers, administrative staff, and scientists from eight teaching hospitals across the city found that screening practices vary widely between hospitals and departments.
  • The study found a number of barriers to IPV screening, including lack of knowledge of IPV or training on how to screen for it, lack of time or prioritization compared to other aspects of patient treatment, and a fear of harming patients further (by not being tactful) or violating their privacy.
  • The researchers concluded that policy makers should make IPV screening a public health priority to improve health outcomes for women and to lessen the burden on the healthcare system through earlier identification and intervention.
    • Universal screening, in which healthcare providers routinely ask women about their experiences with IPV, has proven more effective at uncovering it than case‑finding, in which healthcare workers ask women only if they see signs of abuse.[40]

How do inequities impact health and wellbeing?

Lower-income Torontonians have poorer health, and the situation has not improved in recent years:

  • Extensive evidence has shown a clear link between income and health. Socio-economic circumstances account for 50% of a person’s health.[41]

health-whatshapes

What Shapes Canadians’ Health?[42]
Source: The Standing Senate Committee on Social Affairs, Science and Technology.

 

  • In 2008, Toronto Public Health released The Unequal City: Income and Health Inequalities in Toronto, which showed that there were differences in health between income groups in the city, and that low-income groups had worse health on a majority of indicators.
  • A 2015 follow-up report describes the current relationship between income and health in Toronto and analysed, for the first time, how the relationship has changed over time.
    • For the most recent years of data analysed, 20 of 34 assessed health status indicators showed significant inequities—i.e., low-income groups had worse health. For example, when the health status of the lowest-income group is compared to that of the highest-income group:
      • men are 50% more likely to die before age 75,
      • women are 85% more likely to have diabetes,
      • young women (aged 15 to 24) are twice as likely to be infected with chlamydia, and
      • babies are 40% more likely to be born at a low weight.
    • High-income groups had worse health status in four indicators (including, of note, unhealthy alcohol use). The remaining 10 indicators (including childhood injury, overweight and obesity, and colorectal cancer) showed no differences across income groups.
    • Overall, inequities have not improved. For the first years of data analysed, low-income groups had worse health for 21 of the 34 indicators, and over approximately 10 years inequities persisted for 16, became worse for four, and improved for just one.
      • The relationship between low income and diabetes, for example, has increased in strength over time. While diabetes was more prevalent in 2012 than in 2003 across income groups, its prevalence had increased much more in low-income groups.[43]

health-malediabetes

Male Diabetes Prevalence Over Time in Relation to Health Status and Income, 2003, 2012[44]

 

 

health-femalediabetes

Female Diabetes Prevalence Over Time in Relation to Health Status and Income, 2003, 2012[45]

 

  • The report estimates that, if all income groups in Toronto had the same health status and inequities were erased, it would result in:
    • 932 fewer premature deaths per year,
    • 62,111 fewer diabetics,
    • 1,720 fewer chlamydia cases among youth per year, and
    • 611 fewer low-weight births per year.[46]

Ideas-and-InnovationsSt. Michael’s Hospital has begun to treat poverty as a contributing factor to illness and poor health outcomes that can be “cured”:

  • The hospital has started screening patients’ income levels and offering non-medical services to increase the efficacy of medical treatment. For some patients, for example, staff at the clinic assist by acting as advocates for them with all levels of government, assisting them with applications for access to their Canadian Pension Plan funds or Ontario Disability Support Program income, and providing public transit passes.[47]

 

A comprehensive snapshot of the wellbeing of the city’s youth has shown troubling inequities based on gender, ethno-cultural identity, socio-economic access, and sexual orientation:

  • A 2014 Toronto Public Health survey assessed the sexual, mental, and physical health, along with the health behaviours of more than 6,000 students in grades 7 to 12.
  • Compared to Ontario averages, Toronto students smoke and drink less, but they are less active. Only 7% are meeting Canada’s physical activity guidelines for youth (at least one hour of exercise of moderate to vigorous intensity daily).
    • Males were more likely to meet the guidelines (10% versus 3% female), as were white students (12%, compared to just 3% of East Asians, for example).[48]

 

Meeting the Guidelines for Physical Activity by Gender, Toronto, 2014[49]

Meeting the Guidelines for Physical Activity by Ethno-Racial Identity Group, Toronto, 2014[50]

 

  • While 92% of students reported good or better general health, those with higher “socio-economic access”—i.e., their family’s access to a variety of goods and services—and those who identified as heterosexual were more likely to rate their health as excellent, very good, or good.

 

health-goodorbetersocio

Good or Better General Health by “Socio-Economic Access,” Toronto, 2014[51]

health-goodorbettersexualGood or Better General Health by Sexual Orientation, Toronto, 2014[52]

 

 

Bullying affects not only immediate but long-term mental health:

  • One in five students reported experiencing bullying in the previous 12 months. Bullying was more commonly reported by students in lower grades, by females, and by students who identified as lesbian, gay, bisexual, pansexual, another sexual orientation or unsure about their sexual orientation.

health-bulliedoncepermonthbygradeBullied Once per Month or More in the Past 12 Months by Grade and Sex, Toronto, 2014[53]

health-bulliedoncepermonthbysexualBullied Once per Month or More in the Past 12 Months by Sexual Orientation, Toronto, 2014[54]

 

  • Girls are not faring as well as boys when it comes to mental health and wellbeing.
    • While one in 10 students reported purposely hurting themselves (11%) and seriously considering suicide (12%) in the past year, girls reported self-harm and suicidal thoughts more often than boys. 2% of students reported that they had attempted suicide in the past year.
  • On a more positive note, “school connectedness” was relatively high and there were no noted differences between groups of students. 85% agreed or strongly agreed that “I feel close to people at my school,” and 90% agreed or strongly agreed that “In general, I like the way that I am.”
    • Students who feel connected to their school are less likely to engage in risky health behaviours such as violence and early sexual initiation.[55]

 

 

How safe is our water and what are the risks to our health?

 

Although progress has been made in upgrading water infrastructure, issues around affordability and access to information still place vulnerable Toronto households at risk of exposure to lead in their drinking water:

  • A report from Toronto’s Medical Officer of Health to the Board of Health shows that action by both the City and the public to mitigate exposure has had some success.
    • Between 2007 and 2014, the percentage of the 475,000 residential water service connections in Toronto assumed to be made of lead dropped by about 46% (from 65,000 in 2007 to 35,000 in 2014).
  • Nonetheless, tests of drinking water in 2011-2013 found dangerous levels of lead in about 15% of samples. Toronto Water offers residents free testing for lead in their drinking water. In 2011-2013 the majority of samples tested were low in lead, but about 15% showed 10 parts per billion or greater. [56]

 

health-led-NEEDSCREDIT

Residential Drinking Water Sample Results, Toronto, 2011-2013[57]

 

  • Lead components may exist in both the public and private side of the drinking water system, and the cost of replacing them is a barrier to some homeowners.
    • Research has shown that cost is the greatest barrier to full replacement. Other municipalities—Ottawa, Hamilton, London, Brantford, Welland, and Guelph—offer residents financial assistance as incentive.[58]
    • The City pays to replace the portion of City-owned lead pipes connected to houses up to the property line, but homeowners are responsible for replacing the portion of pipes on their own property—at a typical cost of about $3,000.
  • A 2011 City report estimated that 70% of Toronto property owners whose services were upgraded on the City’s side did not upgrade their portion.[59]
  • The Medical Officer of Health also notes that although the City has a variety of risk mitigation strategies, including a free filter program, a filter rebate program, and the Toronto Water testing program, awareness of many of these—as well as awareness of the risks associated with lead in drinking water—is not high enough. Vulnerable subpopulations and tenants in particular may experience barriers to accessing information and taking action.[60]
  • Exposure to lead can affect the brain and nervous system. In adults, symptoms include hypertension and kidney failure. Lead exposure is most dangerous, however, to fetuses, infants and children under six. In young children, symptoms include shortened attention span, reduced IQ, ADHD (attention deficit hyperactivity disorder) and behavioural problems.
  • Health Canada considers lead levels below 10 parts per billion safe. Many medical researchers disagree, saying that any level of lead in drinking water is unsafe.[61]

 

 

How healthy are the city’s adults and children and what strategies are being proposed to promote active, healthy lifestyles?

 

Children aren’t getting enough exercise, and parental fears, lifestyle choices and social pressures may contribute to the problem:

  • A 2014 study out of Ryerson University explores the effect on children’s physical health of being given freedom to explore places within their neighbourhoods without adult supervision.
    • The researchers surveyed more than 1,000 parents and caregivers of students in Grades 5 and 6 in 16 Toronto public elementary schools, while the students wore an accelerometer for seven days.[62]
    • The study found that parents’ or caregivers’ perceptions of the “social environment” influenced children’s physical activity—for example, if parents were afraid for children’s safety, they would be less willing to let them out on their own without supervision, and the longer the parents lived in same residence, the more likely they were to allow more unsupervised time outside of the residence.
      • Children who were allowed at least some time to go out and explore on their own or with friends were 14 to 19% more physically active than kids who were always supervised.[63] Yet only 16% of parents reported that they either frequently or always allow children to travel independently.
      • About 35% of parents reported that they never allow children to go out on their own or with friends. Parents who preferred active modes of transport were more likely to do so.[64]
      • Children in playgrounds tended to be more active when their parents weren’t around.[65]
    • The physical activity report card released by ParticipACTION shows that only 14% of 5- to 11-year-old and 5% of 12- to 17-year-old Canadian children are meeting the recommended 60 minutes per day of moderate to vigorous activity. Toronto kids accumulated, on average, only about 30 minutes a day.[66]
      • The organization says that keeping kids indoors is a bigger risk than giving kids access to active, self-directed play outdoors, which is essential for healthy child development.[67]
    • Sedentary behaviours in children (such as prolonged sitting, using motorized transportation, watching television, and playing passive video games) continue to be associated with poor health outcomes including disordered sleeping and obesity-related measures such as higher body-fat percentages, waist-to-hip ratios, and body mass index (BMI) measures.[68]
      • Children’s sedentary behaviour is linked to parents’ income and education. University-educated parents with annual household incomes of $100,000 or more are generally less likely to report that their child engages in sedentary pursuits for at least two hours during the after-school period than are parents without a university education and with lower household incomes.[69]
      • The Sedentary Behaviour Guidelines of the Canadian Society for Exercise Physiology offer suggestions to decrease sedentary behaviour in youth:
        • encourage active transportation to school,
        • encourage active play after school,
        • become active as a family in the evenings, and
        • encourage teens to visit friends instead of texting them.[70]
      • The Province, meanwhile, mandates 20 minutes of daily physical activity within instructional time in elementary schools. 82% of Toronto’s elementary schools have a Health and Physical Education teacher, and 63% employ one full time.
        • The Province announced in November 2014 that it would work with the Active at School coalition (of private, public, and not-for-profit organizations) and the Ontario Physical and Health Education Association to implement programs to ensure that young people get 60 minutes of physical activity per day.
        • Research shows that early exposure to comprehensive health programs has a positive impact on students’ short- and long-term health and may help to reduce the prevalence of chronic diseases in adulthood.[71]

 

With eight of the top 10 causes of death in 2009 in Toronto being chronic diseases, a City of Toronto report outlines design principles that would allow residents of all ages and abilities to incorporate physical activity into their daily routines:

  • Physical activity and obesity can be factors in a variety of chronic diseases.
  • Active City: Designing for Health presents principles to guide changes to our built environment (our neighbourhoods, streets, and buildings) to encourage active living.[72]

 

health-top10Top 10 Causes of Death in Toronto, 2009[73]

health-10principles10 Principles for an Active City[74]

Small Money Can Make a Big Difference in Teens’ Lives:

  • With only 4% of Canadian teens aged 12-17 getting enough daily physical activity, ParticipACTION is empowering 13- to 19-year-olds to make a difference by actively identifying and hosting creative new physical activity events in their communities.
  • Ideas-and-InnovationsWhile many factors can inhibit a child’s access or ability to engage in physical activity, an obvious barrier is cost. The 10-year, $10M ParticipACTION Teen Challenge provides microgrants of $250 to $500 to teens who organize physical activity events.
  • A study found that the microgrants were sufficient to enhance communities’ capacities to provide opportunities for adolescents to engage in physical activity.
  • The program operates via a network 13 provincial/territorial coordinating organizations that support communities at the local level.[75]

 

How can sport and recreation contribute to the city’s health and wellbeing?

 

The City of Toronto spends $778 per household on recreation and culture, for a total expenditure of $861,716,000 or 0.09% of total household expenditures:

  • Comparatively, Calgary spends $474 per household (for a total expenditure of $211,142,000 or 0.22% of total household expenditures), and Regina spends $736 ($61,196,000 or 1.2%).[76]

 

Despite criticisms of major international sporting events in other cities, there is optimism that the Toronto 2015 Pan/Parapan Am Games will create a lasting and positive legacy of health:

  • Now that the Games are over, local municipalities and universities that invested in new facilities for them (such as theBack Campus Fields on the University of Toronto’s St. George campus) will be motivated to promote “sport for all.”
    • 44% of funding for new facilities came from these financial stakeholders (with the other 56% coming from the Federal government).
  • Improvements to the city’s parks and trails for the Games have created greater usability and wayfinding for users.[77]

 

Ideas-and-InnovationsFriends of the Pan Am Path was at the heart of a movement to link up some of Toronto’s underused green spaces and connect neighbourhoods across the city:

  • The Pan Am Path is a multi-use recreational pathway that will connect Toronto’s trails and create for walkers, runners, and bikers an active-living legacy of the Toronto 2015 Pan Am/Parapan Am Games.
  • Made up of over 80km of continuous trail across the city, the Path will connect the city’s residents, local organizations, artists and businesses to create truly vibrant public spaces that reflect the communities along the route.[78]
    • From May 16 to August 15, 2015, the Pan Am Path came alive with an Art Relay festival of art installations and events. Each week, the festival travelled across Toronto to celebrate the city’s diversity, nature, and arts.[79]
  • The City expects that once the Path is complete in 2017 it will be used by thousands of residents every year. It has the potential to become a high profile tourist attraction in its own right.[80]
  • To date, Pan Am Path arts programming and cross-city community building has led to:
    • 14 activations and local festivals on the Path,
    • The engagement of over 100 organizations from across city,
    • 24 permanent or semi-permanent art installations,
    • 84 performances (dance, music, etc.), and
    • 2 new permanent exhibition/art/gallery spaces.[81]

 

health-panampath

Toronto Pan Am Path Route[82]

 

 

The following groups are addressing issues relating to health and wellness through their innovative community-based programs.

 

Click on the name of the group to be directed to their profile on the Community Knowledge Centre to learn more about how.

 

Access Alliance Multicultural Health and Community Services – Improving health outcomes for the most vulnerable and their communities

Alzheimer Society of Toronto – Alleviating personal and social consequences of dementia

Art Starts – Creating social change through community art projects

Arthritis Research Foundation – Working to beat arthritis and autoimmune diseases

Alliance for South Asian Aids Prevention (ASAAP) – Providing HIV/AIDS sexual health and support services

Big Brothers Big Sisters of Toronto – Mentoring young people across the nation

Birchmount Bluffs Neighbourhood Centre – Offering recreational, social and capacity building programs

Boost Child Abuse Prevention and Intervention – Working to eliminate abuse and violence towards children and youth

Broad Reach Foundation for Youth Leaders – Increasing leadership skills for underserved teens through sailing

Camp Oochigeas – Providing kids with cancer a unique, enriching and magical experience

Canadian Diabetes Association – Fighting diabetes by helping people live healthy lives while finding a cure

Canadian Music Therapy Trust Fund – Improving the mental, physical and emotional health of Canadians

CANES Community Care – Assisting seniors to take part in the life of their community

Carefirst Seniors & Community Services Association – Ensuring that Chinese seniors live a quality & enriched life

Casey House – Providing support for those affected by HIV/Aids

Central Toronto Youth Services – Serving youth who have a range of mental health needs

Centennial Infant and Child Centre Foundation – Educating young children with developmental challenges

Centre for Spanish Speaking People – Serving new immigrants from 22 Spanish-speaking countries

Charlie’s FreeWheels – Teaching bicycle mechanics, safety and leadership skills to youth

Child Development Institute – Leading children’s mental health programming in Toronto

Coleman Lemieux & Compagnie – Presenting professional dance performances in Toronto and around the world

Community Association for Riding for the Disabled (CARD) – Improving lives through quality therapeutic riding programs

Community Bicycle Network – Providing access, training, and support for all cyclists

Covenant House – Serving youth experiencing homelessness

Davenport-Perth Neighbourhood and Community Health Centre – Supporting their neighbours

Delta Family Resource Centre – Enhancing the potential of families and children

Distress Centres – Creating an emotional safety net for the vulnerable and at risk

The Dorothy Ley Hospice – Fostering hope and dignity for individuals living with life-limiting illness or loss

Dovercourt Boys & Girls Club – Providing a safe, supportive place for children and youth

Earthroots Fund – Dedicated to the preservation of Ontario’s wilderness, wildlife, and watersheds

Eastview Neighbourhood Community Centre – Serving a low-income, ethnically and socially diverse community

Elizabeth Fry Toronto – Supporting women have been or are at risk of being in conflict with the law

Eva’s Initiatives for Homeless Youth – Working locally and nationally to prevent, reduce, and end youth homelessness

Evergreen – Solving the most pressing urban environmental issues

Family Service Toronto – Strengthening communities through counselling, education, social action and development

FoodShare – Working towards a sustainable and accessible food system

Fred Victor – Providing accessible housing to people experiencing homelessness and poverty

FutureWatch Environment and Development Education Partners – Fostering the creation of sustainable communities

The Gardiner Museum – Leading arts education and therapy through clay and ceramics

Geneva Centre for Autism – Empowering and supporting individuals with an Autism Spectrum Disorder

Gilda’s Club Greater Toronto – Empowering, strengthening and sustaining people impacted by cancer

Green Thumbs Growing Kids – Engaging young people with nature and food through gardening

Greenest City – Building healthy neighbourhoods through gardening and the celebration of food

The Gatehouse Child Abuse Investigation & Support Site – Building courage and hope in those touched by child abuse

The George Hull Centre for Children and Families – Serving children and youth by providing mental health services

The Good Neighbours’ Club – Welcoming homeless men into a safe space through a drop-in centre

High Park Nature Centre – Promoting awareness and respect for nature through outdoor education

Hospice Toronto – Facilitating access to compassionate care

Interval House – Enabling abused women and children to have access to safe shelter and responsive services

John Howard Society –Supporting rehabilitation and re-integration of those in conflict with the law

Lake Ontario Waterkeeper – Working to restore swimmability, drinkability and fishability to Lake Ontario

Lakeshore Area Multi-Service Project (LAMP) – Partnering with the community to address emerging needs

LGBT Youth Line – Providing anonymous peer support for youth in a queer-positive context

LOFT Community Services – Helping people with challenges including mental health and addiction issues

Lumacare – Providing essential programs and services for the support of seniors

MABELLEarts – Bringing together local communities to make art, tell stories, and creatively transform their public space

Make-A-Wish Foundation – Granting the wishes of children living with life-threatening medical conditions

March of Dimes Canada – Creating a society inclusive of people with physical disabilities

Mentoring Junior Kids Organization (MJKO) – Promoting healthy and active lifestyles for youth

METRAC – Focusing on education and prevention to build safety, justice and equity

The Massey Centre for Women – Striving to achieve healthy outcomes for all young mothers and families

National Ballet of Canada – Performing the masterworks of classical and contemporary

Native Women’s Resource Centre of Toronto – Building the collective capacity of Aboriginal women

Neighbourhood Information Post (NIP) – Empowering marginalized and socially isolated people

Nellie’s Women’s Shelter – Operating services for women and children who have experienced and are experiencing violence, poverty and homelessness.

New Leaf Yoga Foundation – Supporting the well-being of youth by making mindfulness and yoga accessible

New Visions Toronto – Providing services for individuals with developmental and/or physical disabilities

Newcomer Women’s Services Toronto – Delivering educational and employment opportunities for immigrant women and their children

North York Harvest Food Bank – Creating community where all members can meet their food needs

North York Women’s Centre (NYWC) – Supporting and empowering women and effect positive change

Not Far From The Tree – Putting Toronto’s fruit to good use by picking and sharing the bounty

Oolagen – Empowering youth and their families to enhance their wellbeing and mental health

Ophea – Championing healthy, active living in schools and communities

Outward Bound Canada – Cultivating resilience and compassion through challenging journeys in nature

Parasport Ontario – Developing and promoting Paralympic and ParaSports in Ontario

Parkdale Activity Recreation Centre (PARC) – Working with members of the Parkdale community on issues of poverty and mental health

Pediatric Oncology Group of Ontario – Championing childhood cancer care

The Peer Project – Youth Assisting Youth – Promoting the healthy growth and development of young people

Planned Parenthood Toronto – Serving youth with a focus on sexual and reproductive health

Project Canoe – Using the outdoors and wilderness canoe trips to help youth develop life skills

The Psychology Foundation of Canada – Translating psychological research into state-of-the-art programs

Regeneration Community Services – Promoting self-determination and a higher quality of life for people living with mental health issues

Renascent Foundation Inc. – Facilitating recovery, education and prevention relating to alcohol and drug addictions

Ronald McDonald House Toronto – Providing a ‘home away from home’ for ill children and their families

Roots of Empathy – Reducing bullying among school children while raising emotional competence

Scadding Court Community Centre – Providing opportunities for inclusive recreation, education, and community participation

Scarborough Centre for Healthy Communities – Cultivating vital and connected communities

Second Harvest – Feeding hungry people by picking up, preparing and delivering excess fresh food to social agencies

Seeds of Hope Foundation – Building sustainable communities with resource centres that encourage learning, recovery, and enterprise

Seed to Table – Cultivating the conditions for community change by building local capacity

Sheena’s Place – Supporting individuals, families and friends affected by eating disorders

Sherbourne Health Centre Corporation – Providing healthcare and transformative support to those experiencing systemic barriers

Sistering: A Women’s Place – Offering emotional and practical supports enabling women to take greater control over their lives

SKETCH Working Arts – Creating a safe space for arts and creativity for young, marginalized people

SkyWorks Charitable Foundation – Advocating and participating in social change through community film making

South Riverdale Community Health Centre – Improving the lives of people that face barriers to physical, mental, and social well-being

Springboard – Helping people develop the skills they need to overcome barriers and achieve their full potential

SPRINT Senior Care – Caring for seniors and enabling seniors to care for themselves

St. Paul’s L’Amoreaux Centre – Providing programs and services for seniors and older adults

St. Stephen’s Community House – Programming for newcomer and low-income residents

Street Health Community Nursing Foundation – Improving the wellbeing of homeless and under housed individuals

The Stop Community Food Centre – Increasing access to healthy food by building community and challenging inequality

Toronto Youth Development – Assisting and fostering underprivileged youth in Toronto

The 519 – Enhancing the vibrant downtown and LGBTQ* community

Thorncliffe Neighbourhood Office – Building a safe and healthy community

Toronto Foundation for Student Success – Initiating innovative anti-poverty programs for students

Toronto Lords – Providing recreation through basketball for young people in marginalized communities

Toronto Public Library Foundation – Providing essential resources for the enhancement of the Toronto Public Library

Trails Youth Initiatives Inc. – Challenging and equipping youth from the inner city of Toronto

Tropicana Community Services – Providing opportunities to youth, newcomers, and people of Black and Caribbean heritage in Scarborough

Unison Health Community Services – Delivering accessible and high quality health and community services

Variety Village – Promoting appreciation, interaction, empowerment and inclusion

Vermont Square Parent-Child Mother Goose Program – Fostering parent-child bonding and literacy through a rich oral language experience

Wellspring Cancer Support Foundation – Supporting individuals and families living with cancer

White Ribbon – Working to end violence against women and girls by engaging men and boys

Words In Motion – Using the arts to help children and their families achieve their full potential

Workman Arts Project of Ontario – Developing and supporting artists with mental illness and addiction issues

YMCA of Greater Toronto – Offering opportunities for community involvement and leadership

YouthLink – Providing a range mental health services to improve the life outcome for youth at risk

 

 


 

[1] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[2] Government of Canada, Statistics Canada. CANSIM Table 105-0501, Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[3] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[4] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[5] Government of Canada, Statistics Canada. CANSIM Table 105-0501, Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[6] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[7] City of Toronto. Parks, Forestry and Recreation Division. Special request.

[8] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[9] City of Toronto. Parks, Forestry and Recreation Division. Special request.

[10] NVS Table VI-9: Leisure-Time Spent Being Physically Active or Moderately Active (Aged 12-19).

[11] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[12] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[13] NVS Table III-12: Heavy Drinking (Percent of Population, 12 and over Who Consume 5 or More Drinks on One Occasion at Least Once a Month in the Last Year), 2003, 2005 and 2007-2014.

[14] NVS Table III-5: Smoking Rates (Percent) for Current Smokers (Population 12 and over) for Vital Signs Communities by CMA and Health Regions, 2003, 2005 and 2007-2014.

[15] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[16] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent,” Age Group limited to “12 to 19 years.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[17] NVS Table III-15: Rate (Percent of Population 12 years and over) of Influenza Immunization within the Previous Year, 2003, 2005 and 2007-2014.

[18] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[19] NVS Table III-3: Obesity Rates (Percent) of the Population 18 and Over for Vital Signs Communities by CMA and Health Regions, 2003, 2005 and 2007-2014.

[20] NVS Table III-13: Self-Reported Overweight and Obesity Rate (Percent) for Youth (12 to 17 years), 2005 and 2007-2014.

[21] NVS Table III-14: Diabetes Rate (Percent of Population 12 and over), 2003, 2005 and 2007-2014.

[22] NVS Table III-2-ii: Family Physicians per 100,000 Population for Vital Sign Communities by Health Regions, 1997, 2000-2013.

[23] NVS Table III-2-iii: Specialist Physicians per 100,000 Population for Vital Sign Communities by Health Regions, 1997, 2000-2013.

[24] NVS Table III-9: Proportion of the Population (Percent) 12 Years and Over Without a Regular Medical Doctor for Vital Signs Communities by Health Region and CMA, 2003, 2005, and 2007-2014.

[25] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[26] NVS Table X-7: Percentage of Population 12 and Over Satisfied or Very Satisfied with Life.

[27] NVS Table III-7-a: Self-Rated Mental Health (Population 12 and over) by CMA and Health Regions, 2003, 2005 and 2007-2014.

[28] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[29] NVS Table III-7-b: Self-Rated Mental Health (Population 12-19) by CMA and Health Regions, 2003, 2005 and 2007-2014.

[30] Government of Canada, Statistics Canada. CANSIM Table 105-0501. Geography limited to “City of Toronto Health Unit, Ontario [3595-G],” and Characteristics limited to “Percent.” http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050501&paSer=&pattern=&stByVal=1&p1=1&p2=-1&tabMode=dataTable&csid=.

[31] NVS Table III-10: Percentage of People with Perceived Life Stress, Quite a Lot (15 years and over), 2003, 2005, and 2007-2014.

[32] City of Toronto, Toronto Public Health (2014). Suicide Prevention in Toronto. Last accessed September 22, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-73624.pdf.

[33] Office of the Chief Coroner, Ontario (2015). Special Request.

[34] City of Toronto, Toronto Public Health (2014). Suicide Prevention in Toronto. Last accessed September 22, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-73624.pdf.

[35] City of Toronto, Toronto Public Health (2014). Suicide Prevention in Toronto. Last accessed September 22, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-73624.pdf.

[36] City of Toronto, Toronto Public Health (2014). Suicide Prevention in Toronto. Last accessed September 22, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-73624.pdf.

[37] City of Toronto, Toronto Public Health (2014). Suicide Prevention in Toronto. Last accessed September 22, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-73624.pdf.

[38] Now Magazine. (2014). Debate on Subway Barriers sheds light on TTC Suicide. Last accessed September 22, 2015 from: https://nowtoronto.com/news/city-hall/debate-on-platform-barriers-sheds-light-on-ttc-suicides/.

[39] TTC. (2013). TTC renews, extends Crisis Link suicide prevention program. Last accessed September 22, 2015 from: https://www.ttc.ca/News/2013/June/0618_Crisis_Link.jsp.

[40] Centre for Research on Inner City Health. (February 2015). Reaching Out: Asking about Partner Violence in Toronto Teaching Hospitals. http://www.stmichaelshospital.com/crich/wp-content/uploads/finalipvscreeningreportfeb15.pdf.

[41] City of Toronto, Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[42] City of Toronto, Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[43] City of Toronto, Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[44] Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[45] City of Toronto, Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[46] City of Toronto, Toronto Public Health. (April 2015). The Unequal City 2015: Income and Health Inequities in Toronto. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015%20FINAL_Apr15_2015.pdf.

[47] Catherine Porter. Toronto Star. (May 23, 2015). St. Michael’s Hospital health team offers prescription for poverty. Last accessed August 25, 2015, from http://www.thestar.com/news/insight/2015/05/23/st-michaels-hospital-health-team-offers-prescription-for-poverty.html.

[48] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf.

[49] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf..

[50] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf.

[51] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf..

[52] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf..

[53] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf..

[54] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf..

[55] City of Toronto, Toronto Public Health. (March 2015). Healthy Futures, 2014 Student Survey. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Healthy%20School/Files/pdf/StudentHealthSurveyWeb.pdf.

[56] City of Toronto, Toronto Public Health. (July 2014). Health Impacts of the City of Toronto’s Lead in Drinking Water Mitigation Strategy. http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-72536.pdf.

[57] City of Toronto, Toronto Public Health. (July 2014). Health Impacts of the City of Toronto’s Lead in Drinking Water Mitigation Strategy. http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-72536.pdf.

[58] City of Toronto, Toronto Public Health. (July 2014). Health Impacts of the City of Toronto’s Lead in Drinking Water Mitigation Strategy. http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-72536.pdf.

[59] Toronto Star. (2014). Water quality tests data shows elevated lead levels in Toronto homes. Last accessed August 28, 2014, from http://www.thestar.com/news/gta/2014/05/20/water_quality_tests_data_shows_elevated_lead_levels_in_toronto_homes.html; Global News. (2014). Unsafe levels of lead in Toronto tap water: Report. Last accessed August 28, 2014, from http://globalnews.ca/news/1341542/unsafe-levels-of-lead-in-toronto-tap-water-report/.

[60] City of Toronto, Toronto Public Health. (July 2014). Health Impacts of the City of Toronto’s Lead in Drinking Water Mitigation Strategy. http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-72536.pdf.

[61] Toronto Star. (2014). Water quality tests data shows elevated lead levels in Toronto homes. Last accessed August 28, 2014, from http://www.thestar.com/news/gta/2014/05/20/water_quality_tests_data_shows_elevated_lead_levels_in_toronto_homes.html; Global News. (2014). Unsafe levels of lead in Toronto tap water: Report. Last accessed August 28, 2014, from http://globalnews.ca/news/1341542/unsafe-levels-of-lead-in-toronto-tap-water-report/.

[62] CBC. (2015). Kids free to explore and play are more healthy, study finds. Last accessed September 23, 2015 from: http://www.cbc.ca/news/canada/toronto/kids-free-to-explore-and-play-are-more-healthy-study-finds-1.2921273.

[63] Raktim Mitra, Guy EJ Faulkner, Ron N Buliung, Michelle R Stone. (2014). Do parental perceptions of the neighbourhood environment influence children’s independent mobility? Evidence from Toronto, Canada. Urban Studies. Last accessed July 10, 2015 from: http://usj.sagepub.com/content/51/16/3401.

[64] CBC. (2015). Kids free to explore and play are more healthy, study finds. Last accessed September 23, 2015 from: http://www.cbc.ca/news/canada/toronto/kids-free-to-explore-and-play-are-more-healthy-study-finds-1.2921273; Ryerson University. (2015). Unsupervised outings help children be more active. Last accessed June 1, 2015 from: http://www.ryerson.ca/news/news/Research_News/20150122-unsupervised-outings-help-children-be-more-active.html.

[65] Raktim Mitra, Guy EJ Faulkner, Ron N Buliung, Michelle R Stone. (2014). Do parental perceptions of the neighbourhood environment influence children’s independent mobility? Evidence from Toronto, Canada. Urban Studies. Last accessed July 10, 2015 from: http://usj.sagepub.com/content/51/16/3401.

[66] ParticipACTION. (2015). Report Card on Physical Activity for Children and Youth. Last accessed August 23, 2015 from: http://www.participaction.com/report-card-2015/report-card/.

[67] ParticipACTION. (2015). Position Statement on Active Outdoor Play. http://www.participaction.com/wp-content/uploads/2015/03/Position-Statement-on-Active-Outdoor-Play-EN-FINAL.pdf.

[68] ParticipACTION. (2015). Full Report: The Biggest Risk is Keeping Kids Indoors: The ParticipACTION Report Card on Physical Activity for Children and Youth. Last accessed August 23, 2015 from: http://www.participaction.com/wp-content/uploads/2015/03/2015-Report-Card-Full-Report-EN-FINAL.pdf.

[69] ParticipACTION. (2015). Full Report: The Biggest Risk is Keeping Kids Indoors: The ParticipACTION Report Card on Physical Activity for Children and Youth. Last accessed August 23, 2015 from: http://www.participaction.com/wp-content/uploads/2015/03/2015-Report-Card-Full-Report-EN-FINAL.pdf.

[70] Canadian Society for Exercise Physiology. (2015). Canadian Physical Activity Guidelines: Canadian Sedentary Behaviour Guidelines. Last accessed August 23, 2015 from: http://www.csep.ca/CMFiles/Guidelines/CSEP_Guidelines_Handbook.pdf.

[71] People for Education. (2015). Special Report for Vital Signs 2015, Results from Annual Survey of Ontario Schools 2015. Special request.

[72] City of Toronto, Toronto Public Health, City of Toronto Planning, City of Toronto Transportation Services and Gladki Planning Associates. (May 2014). Active City: Designing for Health. City of Toronto.

http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-69334.pdf.

[73] City of Toronto, Toronto Public Health, Planning, Transportation Services, and Gladki Planning Associates. (May 2014). Active City: Designing for Health. Last accessed September 23, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-69334.pdf.

[74] City of Toronto, Toronto Public Health, Planning, Transportation Services, and Gladki Planning Associates. (May 2014). Active City: Designing for Health. Last accessed September 23, 2015 from: http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-69334.pdf.

[75] Business Wire. (January 7, 2015). Small Money Can Make a Big Difference in Teens’ Lives. Last accessed June 1, 2015 from:

http://www.businesswire.com/news/home/20150107005121/en/Small-Money-Big-Difference-Teens%E2%80%99-Lives#.VV57flL3bCR; Katherine A. Tamminen, Guy Faulkner, Chad S. G. Witcher, and John C. Spence. BMC Public Health. (November 22, 2014). A qualitative examination of the impact of microgrants to promote physical activity among adolescents. Last accessed September 2, 2015 from: http://www.biomedcentral.com/1471-2458/14/1206.

[76] NVS Table VII-6: Municipal Spending on Recreation and Culture per Household in Vital Signs Communities, 2012, dollars.

[77] Valerie Iancovich. U of T News. (2015). Can hosting the 2015 Pan Am/Parapan Am Games make Toronto a healthier city? Last accessed September 1, 2015, from: http://news.utoronto.ca/can-hosting-2015-pan-amparapan-am-games-make-toronto-healthier-city.

[78] Friends of the Pan Am Path. (2015). Overview. Last accessed September 22, 2015 from: http://panampath.org/wp.shtml?f=about; Torontoist. (2015). Connecting Toronto One Park at a Time. Last accessed September 23, 2015 from: http://torontoist.com/2014/07/connecting-toronto-one-park-at-a-time/.

[79] Friends of the Pan Am Path. (2015). Overview. Last accessed September 22, 2015 from: http://panampath.org/wp.shtml?f=about.

[80] Friends of the Pan Am Path. (2015). Overview. Last accessed September 22, 2015 from: http://panampath.org/wp.shtml?f=about.

[81] Friends of the Pan Am Path. (2015). Special request.

[82] City of Toronto. (2015). Toronto Pan Am Path Route Map. Last accessed September 20, 2015 from: http://www1.toronto.ca/City%20Of%20Toronto/Strategic%20Communications/Pan%20Am%202015/Links/2015-04-28_Toronto_PanAm_DistanceIndicator.pdf.