Dr. Stephen Hwang, staff physician at St. Michael’s Hospital in Toronto
Canada needs to address a hidden emergency in housing. No, it's not an impending U.S.-style mortgage meltdown. Nor, surprisingly, is it homelessness, a problem that can hardly be considered "hidden" after the mayors of Canada's biggest cities declared homelessness a "national disaster" 12 years ago and the United Nations declared homelessness in Canada a "national emergency" in 2007.
The truth is, an incredibly large number of Canadians are "vulnerably housed." These low- and moderate-income individuals and families are spending more than 50 per cent of their income on rent. In many cases, their housing is in poor condition and doesn't provide the basic safety, security and space that a person needs to be healthy.
Equally important, the meagre funds left after paying the rent are often inadequate to provide for other basic necessities such as food. The fact that more than 860,000 Canadians are using food banks each month is, in part, a reflection of an underlying housing problem - namely, the lack of affordable housing for people on limited incomes.
Each night, more than 17,000 Canadians sleep in homeless shelters or on the street. But for every person who's homeless in Canada, there are 23 households that are vulnerably housed and at high risk of becoming homeless. Across the country, more than 380,000 individuals and families are living in this precarious state.
Our research shows that people who are vulnerably housed often face the same severe physical and mental health problems as people who are homeless. In Vancouver, Toronto and Ottawa, many vulnerably housed individuals are just as likely as homeless individuals to have serious health conditions, to be unable to access needed health care, and to use the emergency department or be admitted to hospital.
As a physician who has provided care for patients who are homeless and those who are vulnerably housed, I have seen that the health problems and needs of people who are housed but living in marginal situations are often as severe as people living in shelters. In fact, those who are vulnerably housed often suffer from the fact that they are hidden away from the public eye and forgotten. Their health problems are the consequence of poor access to affordable, decent and appropriate housing.
It's often during a transition period or crisis that people fall through the cracks in our health and social safety programs, and housing vulnerability becomes a serious risk. For example, disproportionate numbers of homeless people in Canada have a history with the child welfare system; when kids exit foster care, they often have few resources, no family or community support, and nowhere to go. Fleeing domestic violence comes with a huge risk of homelessness, as does re-entering society from jail. Patients are often discharged from hospitals and psychiatric wards directly to shelters or the street.
Once homeless or vulnerably housed, these economically and socially marginalized groups are exposed to additional - and often severe - mental and physical stress, and encounter frequent barriers to receiving health care. What they need is a safe environment to recover and work out the issues that contributed to their housing problems. Everyone should be able to access - and keep - housing that supports their health.
Our commitment to accessible health care for all, enshrined in the Canada Health Act, is part of our national identity, and few would doubt the need for a co-ordinated strategy on health care. Today, however, Canada is the only G8 country without a national housing strategy. This gap has its gravest impact on our most vulnerable citizens. Fundamentally, we need to recognize that decent and affordable housing is just as essential for the health of our population as accessible health care, wholesome food, clean air or fresh water.
Bill C-304, which is undergoing third reading in the House of Commons, calls for a national housing strategy that would ensure secure, adequate, accessible and affordable housing for all Canadians. It's crucial that this bill is passed, and that we make a shared commitment to moving forward with concrete objectives and deliverables in the area of affordable housing. Progress in protecting and promoting the health of Canadians depends on action to ensure healthy housing for all.
Stephen Hwang, a staff physician at St. Michael's Hospital in Toronto and a research scientist at the hospital's Centre for Research on Inner City Health, is a leading expert on homelessness and health in North America.