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Op-ed: Marchell Coulombe

Housing is health care, and public health should be leading the charge

By Marchell Coulombe

It’s no surprise that access to safe, stable, and appropriate housing is essential for good health.

We know, and have known for some time, that living and working conditions are the predominant factors that shape health outcomes.

Housing is a social determinant of health in Canada, a necessary requirement for a healthy life. Lack of adequate housing continues to pose serious risks to the health of Canadians and impacts the health-care system.

At least 235,000 Canadians experience homelessness each year.

On any given night, at least 35,000 people find themselves with no place to sleep.

Hidden homelessness is also a serious problem and often goes underreported; 50,000 Canadians may be relying on couch surfing with friends, family or acquaintances and are without any immediate prospects of more stable housing options.

Housing is more than looking at homelessness, however.

National housing strategy?

One out of every three Canadian households live in inadequate, unacceptable or unaffordable housing.

Up until 2017, Canada was the only G8 country without a National Housing Strategy.

The primary objective of Canadian health-care policy is to “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

Health-care policy in Canada therefore must include provisions for safe, stable and appropriate housing. Access to housing and issues related to homelessness are certainly health issues, but very few Canadian studies have considered it that way.

“A national study in 2010 found that people without a healthy place to live were more likely to deal with complex chronic health conditions.”

A national study in 2010 found that people without a healthy place to live were more likely to deal with complex chronic health conditions like hepatitis B and C, asthma, high blood pressure, chronic obstructive pulmonary disease, diabetes, ulcers, heart disease, HIV, cirrhosis and cancer.

Further, people without access to stable housing options are at greater risk of being hospitalized, suffering with mental health and substance use issues, and have difficulty accessing necessary health care; 77 per cent report visiting an emergency department at least once a year. 

Additionally, people without access to stable housing report increased rates of physical and sexual violence, have difficulty accessing food or experience difficulties with mobility.

Decent, stable and appropriate

To support good health, housing is more than just having shelter.

It needs to be decent, stable and appropriate to the specific needs of the individual.

Decent housing is safe and clean, and offers both privacy and protection, as well as personal space. Stable housing is affordable, costing less than 30 per cent of total income, including utilities.

Appropriate housing might include the necessary supports to ensure someone is successful; this might include supported housing models that incorporate medical care, mental health support, and substance use support.

Seventy-five per cent of Canadians believe it’s urgent to end homelessness in Canada but ending and preventing homelessness and housing insecurity will require investments from all levels of government that can be difficult to justify or advocate for.

“It costs us more to do nothing than it would be to invest in long-term solutions.”

Frequently missing from these discussions is the cost of maintaining the status quo. Homelessness costs approximately $7 billion per year in Canada.

Current responses to homelessness are ones that are largely dependent on emergency services; a response that not only generates poorer health outcomes, but one that is also very expensive.

Targeted approaches like Housing First, where individuals are provided appropriate housing along with necessary supports regardless of sobriety, employment status or other factors, have been shown to be cost-effective in the long term compared to the status quo.

Essentially, it costs us more to do nothing than it would be to invest in long-term solutions.

Opportunity for change

The COVID-19 pandemic has forced us to reconcile housing as an intersecting health and social issue; it became quickly understood that those living in congregated or substandard settings, or those without shelter at all, were at greatest risk of becoming sick and experiencing higher rates of illness and death related to the virus.

A lot of promising policies could come of these lessons if we used it as an opportunity to create lasting change instead of temporary (and costly) solutions.

Housing is absolutely health care, and as we inevitably move from an emergency response into post-pandemic recovery, we need to continue treating it as such.

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