When you’re feeling unwell, whether from a minor cold or a devastating terminal illness, the feeling of home, the desire for a safe and comfortable place to rest and recuperate, is a universal one. But what if your home itself is a source of stress and illness? Worse yet, what if you don’t have a home at all? As family doctors, we see and know just how powerful the effect of proper housing can be on the health of our patients.
On the front lines of healthcare, family doctors have that rare opportunity to stand back and see a person as a whole, in the context of their lives and their social situations. As practitioners of evidence-based medicine, we also seek out the most effective interventions to improve the conditions of our patients; and the evidence is clear. Social factors, like housing, income and wealth, educational background and race are more powerful determinants of health outcomes than our behaviours, genes or even the healthcare system.
And yet, experts in health are often trained to focus on the provision of health care services, often sending patients back into the social and economic conditions that made them sick. Nowhere is this more evident than in the case of individuals experiencing homelessness or living in unsafe, precarious housing.
We treat chronic back pain and send people back to sleep on concrete streets. We treat insomnia and send people back to chaotic shelters where they cannot sleep. We treat asthma and send people back into moldy homes where they labour to breathe. We send patients back to the very places that create their disease.
As healthcare providers, we know the actual prescription needed is safe, secure and affordable housing. We are not alone.
Canada’s former chief public health officer, Dr. David Butler Jones, agrees that inadequate housing can have several negative repercussions on health ranging from “respiratory disease and asthma due to molds and poor ventilation, to mental health impacts associated with overcrowding.
Unfortunately, this issue is not a small one. An overwhelming 1.5 million households in Canada are living in precarious housing that is inadequate, unsuitable and unaffordable. In other words, 1.5 million families live in housing that requires major repairs, does not have enough bedrooms for their needs and pay more than 30 percent of their household income for this unfit housing.
This is not a sustainable situation and it endangers the health of our communities. The 1.5 million in precarious housing does not even count the over 235,000 people a year experiencing homelessness in Canada – those living in shelters, sleeping outside or surfing friends’ couches.
The recent Federal Budget offered $2.3 billion for affordable housing – a step in the right direction. We know some of the funds will be allocated to deal with homelessness, First Nations housing and seniors. While these are positive steps forward, there is yet to be a timeline announced for promised consultations on the allocation of these funds. The federal government’s solution to our housing crisis cannot be about writing cheques and walking away.
When consultations are eventually launched, as health providers who see the impact of these policy decisions on the ground, we have our own suggestions. First and foremost, housing must be viewed as a health and social justice issue. Safe, secure and affordable housing is crucial to maintaining and improving health and well-being.
Secondly, these conversations must include not just the health sector, community partners and think tanks, but most importantly, those with lived experience of homelessness and precarious housing.
Finally, our approach to the housing crisis cannot be one-off policy changes but should be part of a coordinated national housing strategy. This is the very approach recommended by the United Nations Economic and Social Council just this past March. They raised red flags over our insufficient funding for housing, our shortage of social housing units and increased evictions related to rental arrears.
Tackling these problems in a coordinated national housing strategy — not just with short-term spending promises, but with meaningful long-term partnerships — isn’t just good social policy, it’s good health policy too.
It’s time to move from crisis to action, from precarity to security and towards improving housing and health for everyone in Canada.
Article written by Danyaal Raza and Ritika Goel.
Danyaal Raza is an advisor with EvidenceNetwork.ca and Upstream, a family physician at St. Michael’s Hospital and Assistant Professor at the University of Toronto.
Ritika Goel is a family physician with the Inner City Health Associates working with people experiencing homelessness, as well as a Lecturer at the University of Toronto.
