Global Health Advocacy Program
Read about the Global Health Advocacy Program HERE
This Year's Theme: Access to Adequate and Affordable Housing
Housing and Health
Housing as a Social Determinant of Health
An important aspect in examining the health of both an individual and a population is an understanding of the social determinants of health (SDH). SDHs are factors that encompass the non-medical and socioeconomic aspects of health, which includes the critical factor of housing and shelter1. Housing is internationally recognized as a basic and fundamental right in order to achieve a minimum standard of living and health.
What is the State of Housing and Homelessness in Canada?
According to Homeless Hub’s report, State of Homelessness in Canada 2013, 30,000 people are homeless on any given night and 200,000 people experience homelessness in the course of a year. In addition, more than one million Canadian households are in core housing need, defined by the Canada Mortgage and Housing Corporation (CMHC) as spending more than 30% of their income on housing, with a further 380,600 households in severe housing need, spending more than 50% of their income on housing. This situation takes an enormous toll on the health of people in Canada. The cost to the Canadian economy of homelessness is an estimated $7 billion every year, largely due to the increased health care costs associated with more emergency room visits and hospital stays, as well as the higher rates of chronic disease found among those who experience homelessness2. This number, however, encompasses only the extra cost related to those experiencing homelessness. The total economic cost associated with the increased health needs of those in core and severe housing need is likely much higher.
Housing in Canada: Poor Health Outcomes Linked to Housing Insecurity
Canada faces many challenges in addressing the housing needs of vulnerable populations. A recent longitudinal study conducted by REACH assessed the self-reported health of 1200 adults across Vancouver, Toronto and Ottawa who are homeless or vulnerably housed3. There were numerous negative health outcomes reported including deficits in physical and mental health, as well as suffering from abuse and assaults. Importantly, there were also numerous reported limitations in accessing healthcare services due to homelessness or a vulnerable housing situation. Poor housing was linked to a number of chronic health conditions including but not limited to arthritis, hepatitis B, asthma, hypertension and chronic obstructive lung disorders. Further, over one quarter of the adults lived with a loss of mobility and almost forty percent had been assaulted or attacked in the past year. Food security was also poor, as many individuals reported having trouble obtaining an adequate amount of nutritious food.
Mental health is also strongly linked to housing. In the Canadian REACH report over fifty percent of adults in the study had been diagnosed at one time in their life with a severe mental disorder. There was found to be high rates of depression, anxiety, bipolar disorders, schizophrenia and post-traumatic stress disorders. Other studies have shown that homeless and vulnerably housed adults are at a greater risk for suicide, with homeless or vulnerably housed women six times more likely to commit suicide. Importantly, interactions between mental health issues and substance abuse can have a profound impact on the health of the individuals as recent studies have shown that homeless individuals are often struggling with these issues simultaneously1.
In terms of access to healthcare, the REACH report also cited poor outcomes. While the homeless or vulnerably housed in Canada’s three major cities had high rates of physical and mental health issues, almost 40 percent had unmet healthcare needs. Alarmingly, 10 percent were refused services while 20 percent were unaware of where to receive mental health support. These outcomes illustrate that the complex health needs of this vulnerable population are not being properly addressed. Hwang et al. report in their study on inadequate housing and mortality that there is a greater mortality rate among these individuals that cannot be accounted for solely based on lower incomes4. Therefore, housing plays a role in life expectancy and mortality, highlighting the need for strong housing programs worldwide.
Feb 3, 2014 the CFMS brought an ask to parliament, and medical students met with dozens of MPs to bring housing issues to the forefront. We chose to focus on social housing, and this is what we brought to parliament hill:
The Problem in Brief
Over the next 20 years Federal funding for social housing subsidies will gradually expire. Without these subsidies, the housing providers who own and operate these units may not be able to survive without raising rents to market prices or selling off some units, leading to the potential loss of over 600,000 social housing units across Canada. In the context of growing income inequality in Canada, the loss of these social housing units could lead to a great increase in the number of people experiencing housing vulnerability.
Federal leadership is crucial to coordinating efforts to ensure access to adequate and affordable housing to everyone in Canada, and the maintenance of hundreds of thousands of social housing units is essential to provide the infrastructure necessary to achieve this goal. We therefore propose that:
In each budgetary year, beginning with 2014, the federal government reinvest the savings gained from the end of social housing agreements to enable social housing providers to maintain the same number of units with the same affordability, as well as make the necessary retrofits and upgrades to keep the buildings efficient and safe. Any remaining funds should support new affordable housing.
More information about social housing HERE
We're currently in the process of developing a clinical tool for frontline practitioners that will help in caring for those in precarious and vulnerable housing situations
Our team is putting together a policy statement for the CFMS that would specifically lay out our positions and objectives with respect to Housing and Health
Canadian Housing and Renewal Association: http://www.chra-achru.ca/
Wellesley Institute: http://www.wellesleyinstitute.com/
- Wellesley Institute. (2010) Precarious housing in Canada
- Stephen Gaetz, Canadian Homelessness Research Network. ( The real cost of homelessness: Can we save money by doing the right thing?
- REACH (2010). Housing vulnerability and health: Canada’s hidden emergency: A report on the REACH health and housing in transition study.
- Hwang SW, Wilkins R, Tjepkema M, O’Campo PJ, Dunn JR. Mortality among residents of shelters, rooming houses and hotels in Canada: An 11 year follow-up study. BMJ. 2009 Oct 26; 339: b4036.
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