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Putaroofonpoverty dr. turnbull 's presentation adapted



Dr. Turnbull's Presentation

Dr. Turnbull's Presentation
About Healing Homelessness in Ottawa
(adapted for website)



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Putaroofonpoverty  dr. turnbull 's presentation adapted Putaroofonpoverty dr. turnbull 's presentation adapted Presentation Transcript

  • City View United Church Ottawa, Ontario November 1, 2010 The Health Consequences of Poverty in Canada
  • Overview
    • Reflections on poverty & health
        • It’s all about values
    • A community response to a health and social issue
        • ICHP
    • Advocacy: Poverty as an expression of societal values
  • Poverty & Health
  • Poverty is a lack of basic human rights
  • lack of representation and freedom Poverty is powerlessness
  • Caring for Canada’s Most Vulnerable
    • 1 st Nations
    • Rural
    • Single parent families
    • Mentally and physically disabled
    • Psychiatric illness
    • Addictions
    • New immigrants
    • The young and the elderly
  • Advocating for Health
    • As health care providers, opportunities to improve health in both developing and developed countries include:
    • creating effective health delivery systems for prevention and care,
    • anti-poverty measures,
    • direct health care service and
    • effecting positive social change
  • Ottawa Inner City Health An Innovative Model of Collaborative Health Care for the Homeless In Ottawa
  • History of the OICHP Initiative
    • OICHP grew out of strong concern that health needs of chronically homeless were not addressed adequately despite high rates of health service utilization and associated cost.
    Example : in the 7 months prior to admission to the OICHP, this gentleman had 191 trips to The Ottawa Hospital emergency by ambulance. In five months following admission to OIHCP he had 0.
  • Health Care for Vulnerable Populations
    • OICHP partners recognize our collective obligation to provide services to people with severe and persistent mental illness and/or substance abuse who were otherwise barred from receiving services
  • Complexity of Needs
    • In addition to complex physical health problems approx 95% have severe and persistent mental illness and 95% have addictions.
    The typical OIHCP patient is a 45 year old male who is living with HIV, Hepatitis, severe and persistent mental illness and multiple substance addiction who has been homeless or incarcerated 20+ years.
  • The Mission Hospice
    • Serves men and women
    • Shift from AIDs to Cancer care
    • Focus on care for people living with concurrent disorders
    • Importance of culture and community
  • Women’s SCU
    • Mostly serving IDU/sex trade workers
    • Strong partnership with Drug and Mental Health court programs
    • Also have health promotion CD treatment etc
  • Wet Program
    • Very low barrier program
    • Most clients are aboriginal, quite young and, living with a brain injury (ie FASD, ABI or both)
    • Hugely challenging!!
  • Primary Care Clinic
    • - 5 days per week nurse
    • Practitioner
    • -1.5 days per week
    • HIV clinic
    • -1 day per week psychiatric
    • nurse practitioner
    • -dental clinic
  • Oaks Program
    • Supportive housing for seniors, graduates from Managed Alcohol program
    • High intensity of care needs
    • Focus on “normal” living skills and experiences
  • Senior Womens Project
    • Scheduled to open in June 2011
    • Will house 22 formerly homeless seniors women
    • Funded through the Assisted Living Program
  • Treatment Outcomes Successful treatment for condition for which patient was admitted which accords with Canadian standard for care 85% Primary Health Care Needs and Screening for Disease completed 89% Reduction in Risk Behaviors including substance abuse 64% Appropriate use of hospital and EMS services 91% Compliance with Recommended Medical treatment 95%
  • SERVICE SECTOR % PATIENTS RECEIVING SERVICES Hospital Care In patient 26% Out patient 48% Royal Ottawa Hospital 33% Community Health Care CCAC 38% Community Health Centres 50% Community Mental Health Services 13% Housing Supportive Housing Providers 20% Day Programs 8%
    • Patients report
    • -better health,
    • -improved compliance
    • with medical care
    • -less use of emergency
    • health services
    • -reduced substance abuse
    • -sense of community, home and family
    • Service providers report
    • -more efficient service
    • utilization
    • -improved health
    • outcomes for patients
    • -greater compliance with medical care
    • -reduced substance abuse
    • Community partners report
    • Dramatic reduction
    • in public inebriation,
    • panhandling,
    • police contact
    • antisocial behaviours
    • Dramatic increase in positive self care behaviours
  • Pre-Program In Program ER Admission Pre-Program In Program Police Reports *One subject decreased from 5.1 to 4.8 emergency visits per month Pre-program and In-program Emergency Room Visits and Police Reports per  Month by Subject n=17
  • Advocacy: Poverty as an expression of societal values
  • Policy Changes Driving Homelessness
    • Cuts to welfare (example dismantling CAP in the 1990
    • Cuts to social housing
    • Restructuring the health care system
    • Shift from social to individual rights
    • Return to notion of poverty
    • as a personal responsibility
  • Combined with
    • Portrayal of the homeless as not being self reliant, not contributing members of society, exclusion as members of the community
    • Promotion of solutions to homelessness which end dependence on government or community
  • Why have we as a society not been able to:
    • It’s clearly not because of a lack of ability. . Therefore it must be a lack of will
    • Is it our inability as advocates to frame our arguments in terms of values which are “Canadian”?
    • Is it our inability to change policies
    • of the provincial and federal
    • government which have created
    • homelessness?
  • What Are Canadian Values?
    • Value equality, social safety net, safe and healthy communities but:
    • 60% of Canadian endorse the view that “People who don’t get ahead should blame themselves not the system”
    • 53% agreed that “people who don’t work turn lazy”
    • Evidence of deep rooted prejudice against the poor which is tolerated in ways other kinds of prejudice are not
    • We have not effectively advocated for our most vulnerable
    • poverty as an expression of values
    • poverty in the context of a human right
    • anti poverty strategies as cost-effective
    • civic professionalism
    • research: evidence informed decision making
  • Homelessness as a Human Rights Issue
    • People experiencing homelessness face violations of a wide range of human rights
    • Changes the debate from a housing debate to a debate about
    • the rights of citizens who
    • are ENTITLED to
    • protection
  • How Does the Human Rights Argument Advance the “Cause”?
    • Important consequences for how society perceives and treats the homeless
    • Acknowledges that homelessness is more than a housing issue
    • Shifts perception of the homeless as objects of charity to citizens entitled to protection under international law
    • Would require all levels of
    • government to commit to
    • take steps to realize human
    • rights of the homeless
  • Poverty and Health
    • Wealth= Health
    • opportunities for health care providers to improve health include:
    • creating effective health delivery systems for prevention and care,
    • anti-poverty measures,
    • direct health care service and
    • effecting positive social change
    • “ No child left behind”