Inner City Health Associates

Homelessness and poor health are inextricably linked. COVID-19 is another tragic reminder of the vulnerability of people experiencing homelessness, a population with a disproportionately high risk for contracting COVID-19 and suffering severe symptoms and outcomes. While homelessness is one of the most potent social determinants of health, reducing life expectancy by more than 25 years, homelessness and housing have been largely ignored in the design and delivery of healthcare systems across the country.

In less than 15 years, Inner City Health Associates (ICHA) has grown to become the largest homeless health organization in Canada, every year bringing direct access to high-quality primary, mental health, and palliative care to more than 7,000 people experiencing homelessness in Toronto.

ICHA has quite literally moved beyond the walls of conventional health care, taking services and support to people who are homeless wherever they are. Its focus on creating and maintaining relationships with the community has been exemplary from the start. While many organizations may feel that engaging clients who are homeless would simply be too difficult, ICHA’s co-design approach with partners, patients and clients has shown the way. ICHA’s success in removing barriers and co-creating compassionate care programs stems from a cross-sector model that inspires many in health care.

ICHA has grown exponentially as the impact of its innovation model emerged. It has moved from a small group of physicians in 2005 to more than 100 physicians working at 55 decentralized, virtually integrated clinical host sites: shelters, drop-ins, community agencies and housing organizations. Each clinical practice site is founded on equitable and powerful cross-sector partnerships with host shelters/organizations who share a commitment to person-centred care, patient, caregiver and partner engagement, and responsive co-design.

The COVID-19 pandemic has precipitated ICHA’s transformation, from a physician-based organization to one providing interdisciplinary care. Thanks to ICHA’s provincially funded plan, people experiencing homelessness who are affected by COVID-19, are benefiting from clinical nursing and physician services delivered collaboratively with peer support workers and case managers at two recovery sites in Toronto. On-call psychiatry, substance use, and pediatric support are all part of the model of care. This is possible through a broad partnership with community health and social support agencies, the hospital sector, and the City of Toronto.

Today, ICHA is pursuing a proposal to expand its now robustly interdisciplinary outreach clinical services to cover 100% of people experiencing homelessness in Toronto, up from its current 40% coverage. The model would include care in shelters, drop-ins, street nursing and medicine, care for highly vulnerable people who are poorly housed and at risk of eviction, and specialized transitional programs connecting closely with hospitals across Toronto. When realized, this model would create the first fully inclusive healthcare system for people experiencing homelessness anywhere in the world.

ICHA’s approach -- a fundamental cross-sector re-design of the wider community healthcare system -- has the potential to transform care, not only for people experiencing homelessness, but for millions more who live in precarious housing and with other social deprivations. It is a sustainable model, aligned with ICHA’s vision: a healthy end to homelessness.


ICHA has more than 100 physicians and 80 nurses caring for people experiencing homelessness in Toronto.  During the COVID-19 pandemic, ICHA is delivering on its provincially funded clinical and population health strategies to provide collaborative care and clinical services to the city’s homeless community. 

Pictured left to right:  Population Medicine Lead Dr. Aaron Orkin; Clinical Services Director Leigh Chapman; PEACH Team Lead Dr. Naheed Dosani; Clinical Services and Privacy Specialist Alena Ravestein; COVID Recovery site Medical Director Dr. Gary Bloch; COVID Recovery site Medical Director Dr. Ritika Goel; Education Lead Dr. Deborah Pink; Mental Health Lead Dr. Michaela Beder; ICHA Board Chair Dr. Philip Berger; ICHA Operations Director Shivanee Nadarajah; Indigenous Health Co-Lead Dr. Janet Smylie; ICHA Medical Director Dr. Andrew Bond; Executive Assistant Shannon Hirsch; Research Evidence and Quality Lead and Associate Medical Director Dr. Priya Vasa; COVID Recovery site Medical Director Dr. Kate Hayman; Indigenous Health Co-Lead Dr. Suzanne Soush; and ICHA Office Assistant Lindsay Miles. Missing from the photo is Seaton House Lead Dr. Kirsten Dixon.