When you feel 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 universal. 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?
On the front lines of health care, family doctors have the rare opportunity to see a person as a whole, in the context of their lives and social situations. As practitioners of evidence-based medicine, we also seek 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 health-care 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 for 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 mouldy homes where they labour to breathe. We send patients back to the very places that create their disease.
As health-care 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 moulds and poor ventilation, to mental health impacts associated with overcrowding.”
This is not a small issue. An overwhelming 1.5 million households in Canada live 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 per cent of their household income for this unfit housing.
This is not a sustainable and it endangers the health of our communities. The 1.5 million in precarious housing does not even count the over 235,000 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, there is as yet no timeline for promised consultations on allocating these funds. The government’s solution to our housing crisis cannot be about writing cheques and walking away.
When consultations are launched, as health providers who see the impact of these policy decisions on the ground, we have 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 who have experienced homelessness and precarious housing.
Finally, our approach to the housing crisis cannot be one-off policy changes but should be part of a co-ordinated national housing strategy. This is the approach recommended by the United Nations Economic and Social Council in 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 co-ordinated 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.
It’s time to move from crisis to action, from precarious circumstances to security, and towards improved housing and health for every Canadian.
Danyaal Raza is a family physician at St. Michael’s Hospital and assistant professor at the University of Toronto.