This document discusses the health consequences of poverty in Canada and advocates for addressing poverty as a human rights and social issue. It summarizes that poverty negatively impacts people's basic human rights and health, and discusses groups that are most vulnerable like indigenous peoples, single parents, and the disabled. It also highlights the Ottawa Inner City Health Program as an innovative model of collaborative healthcare for the homeless that has improved health outcomes. Finally, it argues that advocates must frame the issue of poverty and homelessness as a violation of human rights and that governments have a responsibility to address poverty through anti-poverty strategies and social change.

1. City View United Church
Ottawa, Ontario
November 1, 2010
The Health Consequences of
Poverty in Canada

2. 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

3. Poverty & Health

8. Poverty is a lack of basic
human rights

9. lack of representation
and freedom
Poverty isPoverty is
powerlessnespowerlessnes
ss

10. Caring for Canada’s Most
Vulnerable
• 1st
Nations
• Rural
• Single parent families
• Mentally and physically disabled
• Psychiatric illness
• Addictions
• New immigrants
• The young and the elderly

11. 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

12. Ottawa Inner City Health
An Innovative Model
of Collaborative
Health Care for the
Homeless In Ottawa

13. 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.

14. 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

15. 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.

16. 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

17. 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

18. 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!!

19. 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

20. Oaks Program
• Supportive housing
for seniors, graduates
from Managed
Alcohol program
• High intensity of care
needs
• Focus on “normal”
living skills and
experiences

21. Senior Womens Project
• Scheduled to
open in June
2011
• Will house 22
formerly
homeless
seniors women
• Funded through
the Assisted
Living Program

22. 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%

23. 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%

24. Patients report
-better health,
-improved compliance
with medical care
-less use of emergency
health services
-reduced substance abuse
-sense of community, home
and family

25. Service providers report
-more efficient service
utilization
-improved health
outcomes for patients
-greater compliance with
medical care
-reduced substance abuse

26. Community partners
report
Dramatic reduction
in public inebriation,
panhandling,
police contact
antisocial behaviours
Dramatic increase in
positive self care
behaviours

27. 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

28. Advocacy: Poverty as an
expression of societal values

29. 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

30. 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

31. 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?

32. 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

33. 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

34. 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

35. 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

36. 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”