"How do we get people off the streets?"
Let's talk about solutions to houselessness
Houselessness is a wicked problem
Too often, we're talking about solutions to houselessness wrong.
Why are we only asking:
How do we get people off the street?
and not,
How do we solve so no one is ever on the street again?
When we only ask, how do we get people off the street? We stop at the most immediate solution: shelter.
When we actually treat housing as a social determinant of health, we can leverage what we know about healthcare systems to develop long-term solutions to ending houselessness.
Our health outcomes are directly correlated to access to shelter
When we only ask, "how do we get people off the street" we fund and create policies that provide immediate shelter, not long-term housing.
Acute solutions (like shelters, emergency funds, warming stations, community centres and food kitchens) are still an integral part of ending houselessness— the same way the Emergency Medical Services (EMS) are an essential part of our healthcare system!
But we would never rely only on EMS for our entire healthcare system because we know that no one should have to wait until an emergency to access to care. Healthcare focused on health prevention and promotion ensures people can live healthy, dignified lives and receive support before they have an acute problem, whenever possible.
Our health outcomes are directly correlated to access to shelter
The average life expectancy is 82 in Canada, but for unhoused people, it is 42.
Unhoused individuals who contracted COVID-19 were:
20x more likely to be admitted to the hospital
10x more likely to be in the ICU
5x more likely to die
If our health outcomes are directly correlated to access to shelter, why are we only solving for emergency services, and not building housing into our healthcare system?
“We need to leverage the learnings of better integrated health and social care to improve health outcomes for marginalized communities across the city.”
Solutions to houselessness
Our health care professionals know that health outcomes are directly correlated with social determinants of health - aka, it's more than your biology and "lifestyle".
But a big reason why our healthcare system doesn't reflect social determinants of health (including housing/shelter) is that politicians are choosing not to hold the private sector accountable.
We need our politicians to start actually treating housing (and other social determinants of health) as critical components of our health and wellbeing - because they are. It's everyday people, especially those systemically neglected, that are being impacted by a healthcare system that isn't designed to help us achieve our best health outcomes.
Here are three learnings to keep in mind:
Learning #1: the cost of proactive versus reactive care
We know that patients entering the hospital for acute issues have worse outcomes that are more costly, and require more care (and as a result more strain on our already underfunded systems).
Meanwhile, proactive and preventative healthcare solutions decrease the strain and cost of acute care on our hospital systems. The same goes for housing!
It is estimated that houselessness costs the Canadian economy over $7 billion per year As private developers continue to profit. Imagine what it would look like to be investing in an adequate supply of safe, affordable and appropriate housing.
Learning #2 - thriving, not just surviving
Our healthcare system is meant to ensure that all individuals are cared for with dignity. Public health is not meant to just keep us alive, but to ensure we have the means to thrive.
This requires all the branches of our healthcare and public health systems, from rehabilitation and occupational therapy to mental health services, pain and harm reduction, etc.
The same applies to housing: we're still arguing over whether to keep warming stations open so people don't freeze to death—when we need to be solving so that folks can not only survive, but thrive.
Learning #3: political will and integrated solutions
As we see in Ontario right now, the intentional destabilization and underfunding of our public system have produced the strain and worker shortages now being used to promote a privatized system. We need all three levels of government to engage in our healthcare system to address these issues and ultimately improve health outcomes.
The same goes for housing as a human right: it's about ongoing commitment & engagement in policy and implementation from multiple stakeholders to address. Housing has a lot of stakeholders - starting with unhoused people. In addition, all three levels of our government are stakeholders, as well as those outside of the public sector, such as private developers, landlords and employers.
But the literal job of the public sector is to care for the public. It shouldn't feel as impossible as it does in Canada.
Case study: UHN Social Medicine addressing housing and health
University Health Network (UHN) and the Gattuso Centre for Social Medicine, in partnership with the City of Toronto and United Way Greater Toronto (UWGT), are creating what is believed to be the first-of-its-kind-in-Canada Social Medicine Supportive Housing site in Toronto.
The proposed four-storey building will provide people from historically-marginalized groups with accessible, safe, secure and affordable housing. The site is being designed with a unique approach, including strategies to address some of the social determinants of health – such as housing, food, and financial security – and their long-term impacts on individuals' quality of life.
This is a welcome example of community solutioning—but we also need to see policies which address the very problem this program is fixing: hospitals are carrying the weight of housing solutions because other sectors are failing to do so.
On Canada Project is excited to introduce University Health Network’s Social Medicine Program’s as one of our OCP Agents of Change 🚀🚀🚀
On Canada Project’s Agent of Change Program helps OCP continue to be an independent media org (with 100% editorial control) while also collaborating with community partners who are very strongly value aligned!
📍About the Social Medicine Program @drandrewbb
UHN Social Med knows that health and poverty are inextricably linked. Social medicine is about defending human dignity and preventing avoidable suffering by taking a more proactive approach to health.
The Social Medicine Program at UHN is focused on integrating social determinants of health (e.g. housing, food) into care delivery and better partnering with community organizations to improve the quality of care for disadvantaged populations.
