Dr. Stephen Hwang is director of the MAP Centre for Urban Health Solutions at Unity Health Toronto’s St. Michael’s Hospital.
As a physician and researcher on homelessness, I’m a witness to the intersecting health crises that affect people who don’t have adequate housing. COVID-19 is only one of them. For years, my colleagues and I have treated infections and overdoses, chronic diseases, injuries and mental health issues among people experiencing homelessness. We have been applying Band-Aids, addressing only the most visible symptoms of a continuing crisis.
The pandemic has forced us to confront the consequences of having allowed homelessness to persist in our cities for far too long. Canadians living on low incomes in crowded conditions have been disproportionally affected by COVID-19. In Toronto alone, more than 500 people experiencing homelessness have been infected with the coronavirus. As case numbers rise and the colder months move us indoors, adequate shelter is more important than ever.
We have seen rapid action on homelessness over the past six months that would have been previously unthinkable. Municipal and provincial governments, health care and service providers, public-health and community agencies have undertaken extraordinary and costly emergency efforts to prevent COVID-19 from spreading rapidly in shelters and encampments. Empty hotels have been quickly turned into temporary housing. Facilities to allow people to safely self-isolate have been created in a matter of weeks. Cities are committing to build new modular housing for people experiencing homelessness.
And now, in last week’s Throne Speech, the federal government announced a new aspiration – to entirely eliminate chronic homelessness in Canada. We must seize this once-in-a-generation opportunity to move beyond short-term, crisis solutions and make lasting change, meet the needs of our communities and end chronic homelessness in our cities. It’s possible, necessary and the right thing to do.
My research on the links between homelessness, housing and health has focused on what works to help people escape chronic homelessness. Many individuals who have been homeless for more than six months, and often far longer, live with multiple long-term health problems. Our studies have shown that despite these challenges, an intervention with rapid access to housing and supports helps people permanently exit homelessness.
However, improved health and well-being requires more than just a roof over one’s head. To make a successful transition, many people – particularly those with serious mental health and substance use issues – need intensive supports: case management, culturally appropriate services that enable healing, harm reduction services, peer support, and connection to primary care, mental health and addiction care. Research shows that investment in these services is not only critical to achieving a lasting reduction in chronic homelessness, but also that much of the costs are offset by reductions in the use of other services.
Our goal must be more than moving people off the street. It must be to help people live full lives and be connected, healthy and well. At a time when we are all struggling with feeling disconnected, this is more relevant than ever. We have seen that governments can move quickly, redirect funding and collaborate for solutions on a large scale when the urgency is there.
Homelessness in Canada is not inevitable; it is the predictable outcome of choices we have made collectively over past decades. We must expand housing and support services to end chronic homelessness. At the same time, we need to address the forces that cause people to become homeless in the first place.
The federal government’s recent commitment to invest in the creation of affordable housing for low-income Canadians is an essential step in this direction. Further work is needed to confront structural racism, especially against Indigenous peoples, and to repair weak social safety nets, particularly for people with disabilities and young people exiting the child welfare system.
COVID-19 has revealed deep inequities in our society. It also offers us a chance to reflect on what we believe as a nation. Are we truly committed to caring for one another? Can we create a new path towards a healthier future for all? How we respond to the problem of homelessness over the coming months and years will provide a clear answer to these questions.
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