• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Environmental Health


Key findings

The number of facilities reporting the use, creation or release of toxic substances under the Ontario Toxics Reduction Act, 2009 (TRA 2009) increased from 819 in 2010 to 1053 in 2013. The number of facilities reporting the use, creation or release of known carcinogens also increased, up from 442 in 2010 to 644 in 2013. Since reporting under TRA 2009 is still in its infancy, it is important to note that the increased number of facilities that are reporting should be perceived as positive. As the TRA is a voluntary program, the increasing number of reporting facilities over the years shows that manufacturing and mining facilities are taking action /looking at ways to ensure toxics use reduction and pollution prevention.

While industrial emissions remain a source of air pollution in Ontario, emission amounts have decreased substantially over the past decade. For example, in 2003 there were 2,423 facilities reporting approximately 1 million tonnes of total releases in air to the National Pollutant Release Inventory (NPRI). In 2014, that amount had decreased to 1,530 companies reporting approximately 600,000 tonnes.

Environment and health in Ontario

There is increasing evidence linking environmental exposures to cancer and other health outcomes1,2. A recent global health assessment estimates that 7% to 19% of cancers are currently attributable to toxic environmental and work-related exposures3–5. Due to the difficulty of directly assessing environmental exposures, we use indirect data on factors influencing "potential" exposure 6. In this report the data is derived from the following:

  1. Use, creation and release of hazardous substances. TRA 2009 collects information on the use, creation and release of hazardous substances. TRA 2009 and Ontario Regulation 455/09 were implemented as a toxic use reduction strategy, with the goal of providing Ontarians better disclosure about the use, creation and release of toxic substances in their communities7, . TRA 2009 was modeled after the successful Massachusetts 1989 Toxics Use Reduction Act8, and it requires selectmanufacturing and mining facilities in Ontario that already federally report their industrial releases to (1) track, account and report on their use, creation and release of select toxic substances on an annual basis; (2) plan for the reduction of each toxic substance (implementation of these reduction plans is voluntary); (3) report and submit summary plans and annual reports on progress; and (4) update plans at least every 5 years.
  1. Hazardous substances released into the environment. A publicly accessible national database that annually tracks the toxic chemicals “released and/or transferred into the environment (land, air and water)" from industrial facilities in Canada is available from the NPRI. This is a mandatory pollutant release reporting program that was established in 1993 under the federal Canadian Environmental Protection Act, 1999 (CEPA 1999)9,10. The NPRI was developed under the guidance of a multistakeholder committee and is modelled after the U.S. Toxics Release Inventory (section 313 EPCRA 1986; 40 CFR Part 372)11. It requires all Canadian industrial facilities that employ 10 or more people to report on 346 select toxic substances that are deemed to pose a threat to human life or the environment if the facilities use more than 10,000 kg of each substance annually.
Table 1. Summary of proposed TRA 2009 indicators, 2010–2013
Indicator 2010 2011 2012 2013 Expected direction of indicator Actual direction of indicator
Total number of industries reporting any toxic substance on substance list each year. 819 804 998 1053 Arrow up Arrow up
Number of industries reporting creation, use or release of known/ suspected carcinogens or those contained in products 442 418 627 644 Arrow Down Arrow up
Number of unique substances reported. 154* 83 236 251 Arrow Down Arrow up
Number of carcinogens reported (known and suspected). 44 38 52 53 Arrow Down Arrow up

*The number of reported substances in 2010 (N=154) exceeded the regulated substances in the 47 priority list.

Table 2. Ontario total releases (in tonnes) reported to the NPRI, water and air, 2003–2014 (Environment Canada 2015)
Year Facilities Unique substances reported Releases to water (tonnes) Releases to air (tonnes)
2003 2,423 193 47,530 1,030,711
2004 2,486 188 57,304 1,011,061
2005 2,507 186 56,842 958,367
2006 2,437 189 54,792 862,181
2007 2,324 197 54,551 813,612
2008 2,191 193 58,767 703,591
2009 2,044 193 52,063 454,188
2010 1,937 189 52,853 521,676
2011 1,818 188 57,496 516,388
2012 1,694 238 58,127 494,062
2013 1,647 239 57,872 505,506
2014    1,530 246117,853594,877

* There have been changes in the NPRI reporting from 1993 to date, especially around the addition, modification and removal of substances. Changes in the thresholds at which different substances should be reported also have been made. Updated information on NPRI releases can be found at Environment and Climate Change Canada.

What do the results show?

Toxics Reduction Act (TRA) 2009

  • In the initial TRA 2009 reports to the Ontario Ministry of the Environment and Climate Change in 2010, 819 facilities reported the use, creation or release of 154 toxic compounds (including known human carcinogens (IARC Group 1) (N=13) and suspected human carcinogens (IARC Group 2A or 2B) (N=31)).
  • There were changes in TRA 2009 reporting after 2010, when the Ministry of the Environment and Climate Change changed from a 47 substance priority list (Table A in O. Reg 455/09) to the NPRI toxic substance list. That increased the number of toxic substances reported to 346.
  • In 2013, 1053 facilities reported the use, creation or release of 251 toxic compounds in air, water or land. Of these, 53 are known or suspected human carcinogens.
  • The number of facilities that reported the use, creation or release of known or suspected human carcinogens increased from 442 in 2010 to 644 in 2013 (Table 1).
  • Known or suspected human carcinogens are still being used, created or released in Ontario.
  • Future indicators will track the change in the amount of toxic substances reported under TRA 2009, as well as the proportion of companies implementing plans to reduce the use, creation and release of toxic substances in Ontario.

Hazardous substances released into the environment (NPRI)

  • The NPRI reports indicate that air emissions have decreased over the last decade. In 2003, 2,423 facilities reported releasing approximately 1 million tonnes of pollutants in the air; in 2014, that had decreased to 1,530 facilities releasing approximately 600,000 tonnes. (Table 2).
  • As noted in Table 2, however, the amount of toxic substances released in water increased from 2003 to 2014.
  • Potential toxicity of the emissions depends on factors like the properties of the compound being released and the medium into which it is released. Weighting factors like benzene-equivalent are typical toxic equivalency potential factors that can be used to take into account differences in toxicity and exposure potential, allowing comparisons of releases on a common scale.

Why is this important to Ontarians?

  • A wide range of toxic chemicals are released from industrial facilities into the air and water, and/or they are transferred off-site for disposal. Many of these chemicals are known to cause cancer, and prolonged exposure to these releases may increase cancer risk.
  • Industrial emissions of different pollutants contribute to air quality in Ontario[ii]. If you live near industrial sources, you may be exposed to higher concentrations of these pollutants than individuals who live farther away.
  • By undertaking the reporting processes required in TRA 2009, manufacturing and mining facilities may have opportunities to reduce toxics through actions such as substituting toxic substances with safer alternatives, increasing process efficiencies (e.g. using less of the substance or reducing waste generation) and reformulating products so less of the substance is needed.

How does Ontario compare with other jurisdictions?

  • Ontario ranked third highest in environmental carcinogen air release in Canada in 2014; several programs and initiatives have been established to reduce the potential health risks associated with chemicals.
  • The Ministry of the Environment and Climate Change has proposed daily and annual standards for carcinogenic environmental contaminants based on toxicology, especially for hexavalent chromium and volatile organic compounds (like benzene and 1,3-butadiene).
  • Ontario has taken a leading role in implementing TRA 2009 as a program that emphasizes industry changes that reduce or eliminate the use of toxic chemicals, the generation of hazardous waste, emissions (to air or land), and by-products per unit of product manufactured.

Find out more

View Notes

  1. Yang M. A current global view of environmental and occupational cancers. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2011; 29:223–249.
  2. Landrigan PJ, Espina C, Neira M. Global prevention of environmental and occupational cancer. Environ Health Perspect. 2011; 119:a280–a281.
  3. Christiani DC. Combating environmental causes of cancer. New Engl J Med. 2011; 364:791–793.
  4. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks [Internet]. Geneva: World Health Organization; 2009. Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf.
  5. Landrigan PJ, Espina C, Neira M. Global prevention of environmental and occupational cancer. Environ Health Perspect. 2011; 119:a280–a281.
  6. Frumkin H. Environmental health: from global to local. New York: John Wiley & Sons; 2010.
  7. Legislative Assembly of Ontario. Toxics Reduction Act, 2009. Chapter 19 [Internet]; [cited 2015 Mar 10]. Available from: https://www.ontario.ca/laws/statute/09t19.
  8. The Government of Massachusetts [Internet]. Commonwealth of Massachusetts; c2016. Toxics Use Reduction Act; [cited 2015 Mar 10]. Available from: http://www.mass.gov/eea/agencies/massdep/toxics/tur/
  9. Environment and Climate Change Canada [Internet]. Ottawa: the Government of Canada. Canadian Environmental Protection Act, 1999. Part 3; 2014 Feb 28 [cited 2015 Mar 10]. Available from: http://www.ec.gc.ca/lcpe-cepa/default.asp?lang=En&n=26A03BFA-1.
  10. Environment and Climate Change Canada [Internet]. Ottawa: the Government of Canada. National Pollutant Release Inventory: tracking pollution in Canada; 2016 Jan 4 [cited 2015 Mar 10]. Available from: http://www.ec.gc.ca/inrp-npri/.
  11. EPA.gov [Internet]. The United States of America Enviromental Protection Agency; 2016. Toxics release inventory (TRI) program; 2016 Mar 1 [cited 2015 Mar 10]. Available at: http://www2.epa.gov/toxics-release-inventory-tri-program.
  1. This includes facilities identified by a North American Industrial Classification System code that begins with the digits “31, ” “32” or “33” (manufacturing), as well as those with the digits “212” (mineral processing). Mineral processing at the facility should involve the use of chemicals to separate, concentrate, smelt or refine metallic or non-metallic minerals from an ore.
  2. Another major contributor to Ontario air quality not addressed in this study is transboundary air pollution.