In 2005, a small group of physicians working with Toronto’s homeless and precariously housed population came together and secured funding from the Ontario Ministry of Health to form Inner City Health Associates (ICHA).

These family physicians, psychiatrists and other specialists saw the dire need for dedicated services and medical care for people experiencing homelessness. The high prevalence of physical and mental illness in this population is compounded by the barriers that many members of the homeless community face daily. Poor access to care and services. No Ontario Health Card. No means to travel to medical appointments. Painful past experiences with healthcare professionals.

Those factors often lead to health problems and crisis, followed by frequent emergency department visits and hospital admissions. To curb that cycle, ICHA brought primary care and mental health services to the community, setting up clinics in shelters, offering services at drop-in centres and joining mobile outreach teams. As the number of people experiencing chronic homelessness, precarious housing and ill health grew, ICHA expanded its membership and services, adding physicians and clinic locations in downtown Toronto, Etobicoke, North York and Scarborough.

In 2011, ICHA was incorporated and a Board of Directors established to set and guide the organization’s strategic direction. The day-to-day operations are facilitated by the ICHA Executive. The ICHA Executive consists of the Medical Director and the Director of Operations. ICHA developed an Education program for medical students and residents, partnered on outreach programs and in 2014 added homeless palliative care to its services (Palliative Education and Care for the Homeless or PEACH). ICHA also pursues and supports research on the social determinants of health and offers opportunities to share and increase knowledge and best practices about homeless healthcare.

While focused on providing access to direct care to people experiencing homelessness, the aim is to link clients to permanent services and support. ICHA works closely with community workers and case managers to address the wide-ranging needs of individual clients. To strengthen co-ordinated, integrated service delivery for the homeless population across the region, ICHA engages with community health and social agencies, civic leaders and public administrators.

The needs that gave rise to ICHA’s creation in 2005 remain. Unprecedented crises such as the Opioid overdose epidemic and COVID-19 present both danger and opportunity. To face and fight challenges old and new, ICHA has established new cross-sector, inter-governmental partnerships and programs with new participants, novel funding arrangements and multi-professional care models. With those components in place, ICHA can offer a strong contribution to creating equitable, integrated services for marginalized communities and system change.

ICHA’s swift and substantive COVID-19 response draws on all its organizational capacities, relationships and resources, including population health, clinical care and outreach, partnerships, program development, research and advocacy.