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Background: Several youth staying at emergency youth shelters (EYSs) in Toronto experience poorly coordinated care for their health needs, as both the EYS and health systems operate largely in silos when coordinating care for this population. Understanding how each system is structurally and functionally bound in their healthcare coordination roles for youth experiencing homelessness (YEH) is a preliminary step to identify how healthcare coordination can be strengthened using a system thinking lens, particularly through the framework for transformative system change., Methods: Forty-six documents, and twenty-four semi-structured interviews were analyzed to explore how the EYS and health systems are bound in their healthcare coordination roles. We continuously compared data collected from documents and interviews using constant comparative analysis to build a comprehensive understanding of each system's layers, and the niches (i.e., programs and activities), organizations and actors within these layers that contribute to the provision and coordination of healthcare for YEH, within and between these two systems., Results: The EYS and health systems are governed by different ministries, have separate mandates, and therefore have distinct layers, niches, and organizations respective to coordinating healthcare for YEH. While neither system takes sole responsibility for this task, several government, research, and community-based efforts exist to strengthen healthcare coordination for this population, with some overlap between systems. Several organizations and actors within each system are collaborating to develop relevant frameworks, policies, and programs to strengthen healthcare coordination for YEH. Findings indicate that EYS staff play a more active role in coordinating care for YEH than health system staff., Conclusion: A vast network of organizations and actors within each system layer, work both in silos and collaboratively to coordinate health services for YEH. Efforts are being made to bridge the gap between systems to improve healthcare coordination, and thereby youths' health outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hudani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

For decades, health education programmes have been based on the assumption that individual behaviours (for example smoking, drug use, eating patterns) are the major risk-factors in contemporary illness. This assumption often led to interventions that subtly "blamed the victim" for his or her ill-health. In recent years the broader social conceptualization of health and illness has directed many health educators' attention towards socio-economic and environmental factors which condition and constrain lifestyle choices, and which may be directly associated with increased disease risks. While it is becoming common for government health departments and agencies to acknowledge poverty, unemployment and other forms of social inequality as potent health hazards, programmes to ameliorate such conditions are rare. Since 1983, the Toronto health department has developed programmes based upon a socio-environmental model of disease which specifically targets social systems rather than individual behaviour for change. Elements of this approach include extensive media reports on the health implications of such issues as welfare benefits, poverty, unemployment and housing; health education programmes to stimulate a critical understanding of the causes and structure of social inequality; health advocacy initiatives to influence political and legislative reforms; and a community development orientation which involves the department in broad-based coalitions working towards healthy social change. Most recently, the department has become a resource to groups attempting to create employment and service community needs through cooperative forms of economic development. Several examples of the department's programmes in each of these areas are provided. To meet the challenge of the World Health Organization's Alma Ata Declaration, health educators must examine their own potential to act as social-change agents, and must become more sophisticated in the political analysis of their practice.