A bit of background:
Toronto has had a serious bed bug problem for some time, just like New York, London, San Francisco, Vancouver–I could go on and on, but you get the idea.
The Toronto Star also has a journalist called Joe Fiorito who wrote extensively and repeatedly about how serious a problem bed bugs were, for everyone who gets them, but especially for the poor, the elderly, the disabled. You can see links to just some of Fiorito’s articles on my del.icio.us page. I mention Fiorito because I do not doubt for a moment the effects that good (or bad) journalism can have on public perceptions of the bed bug problem. In Fiorito’s case, the journalism was very good.
Then in November 12, 2007, Toronto City Councillor Paula Fletcher asked the Board of Health (of which she is a member) to take action on bed bugs. This is a PDF of her letter.
Traditionally Public Health officials consider and have categorized bed bugs as a nuisance because they do not carry and spread communicable diseases. However, ailments stemming from a bed bug infestation can range from secondary infections due to scratching to anxiety, embarrassment, and loss of sleep.
Moreover, residents who experience infestations are faced with considerable financial costs associated with fumigations as well as replacing furniture deemed to be unsalvageable.
Here is a politician who understands the bed bug problem. Clearly, she’s been listening to her constituents.
In the letter, Fletcher specifically asked the Board of Health to
- Review and report on the current procedures for bed bug inspection and control, including changing categorization of bed bugs as a public health ‘hazard’ and the harmonizing pest control under Municipal Licensing which currently deals with pest control relating to mice, cockroaches and termites
- Investigate and report back on a Bed-Bug Furniture Pick-up program
- Investigate and report back on North American best practices, including by-laws relating to sale and disposal of used furniture and mattresses
- [To provide an] Expansion of public education initiatives on measures, particularly to tenants, occupants of multi-residential units and users of shelters
- Report on the City’s regulatory authority to require action from property Owners, Operators of Hotels and Other Multi-unit dwellings including
o Requirements for control and prevention, including pest control management plans included as part of landlord licensing requirements
o Requirements for responding to complaints
o Procedures for reporting to City officials
o Treatment and control of bedbugs in hotel rooms
o Guidelines for pest control companies
o Responsibilities of tenants and homeowners
Fletcher noted that even though property owners are responsible for bed bug eradication, there is a need due to the “resilient and migratory nature” of bed bugs, for government agencies to re-examine their practices regarding the pest.
In response, Dr. David McKeown, the Toronto Medical Officer, unveiled a proposal for dealing with bed bugs last month. He asked the Board of Health to take action, outlined in this PDF.
McKeown’s report opened with a brief introductory paragraph, followed by this statement:
Bed bug infestations occur in all neighbourhoods and communities in the City and most households deal with the problem without assistance from the Municipality. This is not the case with the most vulnerable populations in our community. In recent months, Toronto Public Health has devoted significant resources to deal with severe infestations impacting on the health of the elderly, those living with physical and mental health issues and people living in poverty. This report is intended to focus primarily on strategies to ensure that vulnerable people get the assistance they need to lead independent, pest free lives.
The Medical Officer of Health’s made a series of proposals to the Board of Health (outlined in the same PDF) to deal with bed bugs.
The Board of Health then met on 2/26, and (as outlined in this PDF):
1. requested the Medical Officer of Health to establish an action committee comprised of city divisions, housing providers, health care organizations, social services, community groups, representatives of landlords and tenants, and other appropriate stakeholders to develop a comprehensive action plan to reduce bed bug infestations in the City of
Toronto with particular emphasis on vulnerable populations;
2. requested the Medical Officer of Health to report on the progress of the action committee within six months;
3. requested the government of Ontario to incorporate the issue of bed bug infestations in their poverty reduction strategy; and
4. referred all communications/submissions, and the following motions to the new Action Committee described in Recommendation 1:
Motion by Valerie Sterling:
“That Recommendation 1 be amended by adding the words “and in addition, consider broader public education and social marketing strategy to address the stigma associated with having bed bugs.”
Motion by Councillor Fletcher:
“That the Medical Officer of Health and TorontoPublic Health be requested to educate the medical community in identification of bed bug bites.”
This CBC article which was written in advance of the meeting notes that Toronto’s public health department surveyed PCOs about the increase in bed bug cases. This is the easiest way to get a realistic picture of the number of cases in a city, though of course those who self-treat will be left out.
Toronto Public Health surveyed 12 pest control companies in December 2007 and received six responses. All six reported an increase in numbers of inquires and calls related to bedbugs from 2006 to 2007. The majority of calls were in apartment buildings.
This was an informal check with just 12 companies. Remember the study done in Toronto in 2003? That year, every PCO reported every case of bed bugs in the city (well, theoretically, anyway). Most cases then were in single family homes. That might sound strange to some, since bed bugs are now a much bigger problem in apartment buildings, but it’s fully plausible.
Anyway, the Toronto officials know that if you want to know who has bed bugs in your city, you don’t simply rely on tracking official housing violations (as the New York government is trying to do) or official complaints to the Toronto Public Health Department. You ask the PCOs. Obviously, in this case this is just an informal inqury, not an official study (like the one in 2003). But the principle is the same.
A Toronto Sun article last December noted that the Toronto Public Health Department had gotten 160 calls about bed bugs in the first nine months of 2006. But Reg Ayre, the city’s Healthy Environments manager, said back then that anecdotal evidence from PCOs showed much higher incidence of bed bugs. One PCO claimed to be treating 1200 cases a year, another claimed to treat 400-600 a month (more on that below). You can read more about this here. (Sadly, I cannot link to the original article, since the Toronto Sun is holding out on us, so you’ll have to make do with the report I did on it in December.)
There were other documents associated with the Board of Health meeting, including several fact sheets and this: a PDF of a Toronto Community Housing proposal for dealing with bed bugs in public housing. (The key components, not surprisingly, are educating staff about bed bugs, educating tenants about bed bugs, getting both to cooperate, and using only qualified pest control contractors).
Bed bugs are clearly a problem that is far more serious than current Toronto Public Health data. The officials in Toronto are smart to recognize this. Here in New York, city officials seem happy to cite the number of bed bug cases in NYCHA public housing, or the NYCHPD housing violations for bed bugs, though it is obvious to us that these are just the tip of the iceberg.
The action we’re seeing in Toronto seems to stem in part from
- a vocal and forward-thinking city councillor taking up the cause of bed bugs,
- a persistent and talented journalist taking up the cause of bed bugs,
- a Board of Health willing to re-consider the definition of a “health hazard,”
- a Medical Officer of Health looking deeper into available bed bug statistics, and prioritizing the issue.
Doubtless, there are many more factors I can’t yet see. In any case, I am grateful for all those working to solve this problem in Toronto, and anywhere else.
I can’t overestimate how significant it is that Fletcher and the Board of Health were willing to consider bed bugs as having a significant effect on health. On February 26, other issues the Board of Health was dealing with included the provision of dental care to people on low incomes, and a plan for dealing with an inflenza pandemic. Deadly possibilities like an infleunza pandemic must be planned for, but we also need to deal with bed bugs, even if the health effects are not deadly.
I hope that cities which have not yet taken action will use the work being done elsewhere as a starting point. McKeown’s report, for example, cited what was being done to deal with bed bugs in Vancouver, and Hamilton (Ontario). Problems may vary from place to place, but the bed bug enemy is the same, and cities would do well to use the best practices beginning to be developed elsewhere as a starting point.
I look forward to hearing more from Toronto.
Many thanks to hopelessnomo for helping me think about this issue and for providing the location of the Board of Health’s document stash.