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December 8, 2005


     Housing and health:
    Making the connections,
         taking action
         Michael Shapcott, Senior Fellow
           Wellesley Central Health Corporation




                                                  1
What do we know. . .
1. Lack of good quality, affordable
   housing affects health
     homelessness, insecure housing
     higher morbidity and higher motality

2. Subsidized housing is key factor in
   helping the homeless become housed
     housing    housed

                                            2
Toronto flop house, 1914




                           3
The Bruce Report (1934)

  A study of Toronto’s slum districts at the
  depths of the Great Depression:
    “These areas of misery and degradation
    exert an unhappy environmental influence
    upon many of our citizens.”
                Dr. H.A. Bruce, Lieutenant-Governor of Ontario




                                                           4
Housing and health (1984)
  “Inadequate accommodation is not sole
  solution to health problems among Toronto’s
  poor, but being homeless or living in
  unaffordable or substandard housing makes it
  difficult, if not impossible, to engage in many
  practices that promote health. Moreover,
  inadequate housing foster stress which
  lowers physical resistance to disease and
  exacerbates pre-existing emotional strains.”
 Housing and Health: Public Health Implications of the Crisis in Affordable
                     Housing, Toronto Department of Public Health, 1984


                                                                        5
Homelessness and health
 “Specific health effects of homelessness and
 underhousing are difficult to separate from often-
 associated effects of poverty, unemployment, pre-
 existing mental and physical disabilities, and age-
 related vulnerabilities in children and the elderly. . .”
 “The health effects of homelessness include:
    cold injury [hypothermia and frostbite];
    cardio-respiratory disease [coronary artery disease, high
    blood pressure, emphysema]
    tuberculosis;
    skin problems [infected and ulcerated lesions];


                                                                6
Health effects of homelessness
    nutritional disorders [leading to a greater risk for
    infectitious diseases, gastrointestinal disorders, skin disease
    and nervous system dysfunction];
    sleep deprivation [leading to instability, emotional irritability,
    concentration deficits, cognitive impairment, apathy and
    behaviour disorders];
    children’s mental health disorders [leading to
    developmental lags, anxiety, depression, learning
    difficulties];
    adult psychiatric disorders; and
    chronic stress [including insomnia, anxiety, depression,
    loss of self-esteem and withdrawal].”
                          Public inquiry into homelessness and health, 1987



                                                                        7
Morbidity and mortality
  “Homeless women and men do not have
  ‘different’ illnesses than general population.
  However, their living circumstances and
  poverty affect their ability to cope with health
  problems.” - Street Health Report, 1992
  Homeless women and men have mortality
  rates 8 to 10 times higher than housed
  women and men - Dr. Stephen Hwang


                                                 8
Bed bugs. . .
   “The rise of bed bugs is a concern for many
  reasons. First, the nocturnal blood-sucking
  habits of the bugs induce anxiety, worry,
  stress, and sleeplessness for those infested.
  The initial bite, though usually painless, may
  develop into a welt that remains itchy for
  weeks. With scratching and subsequent
  infections, these welts can develop into
  severe skin conditions.

                                               9
…a biological indicator
  “Bed bugs may be a biological indicator
  of changing social conditions and might
  foretell the resurgence of other
  ectoparasites such as lice and fleas and
  their associated diseases.”
  Dr. Timothy Myles , Bed bugs in Toronto, Research Bulletin #19,
                        Centre for Urban and Community Studies,
                                       University of Toronto, 2003



                                                              10
The homelessness disaster




                            11
Homeless families in NYC
  Predictors of Homelessness Among
  Families in New York City: From Shelter
  Request to Housing Stability

  American Journal of Public Health
  Volume 88(1), November 1998,
  pp.1651 to 1657

                                       12
Method
 568 homeless and housed poor families
 First interviewed in 1988, then
 interviewed again in 1993
 Questions:
   Who was stably housed (> one year)?
   Why were they stably housed?



                                         13
Factors not affecting stability
  NOT – race, age, pregnancy, persistent
  poverty, education, work history,
  marriage, teen motherhood, child
  poverty, mental illness, substance use,
  physical health, incarceration, social ties
  domestic violence, childhood
  disruptions


                                          14
Who was stable?
  80% of families who went into
  subsidized housing

  18% of families who went into
  unsubsidized housing




                                  15
Only factor affecting stability

  Subsidized housing

  Marybeth Shinn: “Subsidized housing is
  both necessary and sufficient to ‘cure’
  homelessness among families.”



                                       16
Housing succeeds. . .
  “We found that subsidized housing succeeds
  in curing homelessness among families,
  regardless of behavioral disorders or other
  conditions. Whatever their problems –
  substance abuse, mental illness, physical
  illness or a history of incarceration – nearly all
  of the families became stably housed when
  they received subsidized housing.”


                                                 17
Spruce Court, 1914




                     18
Regent Park, 1948




                    19
Oak Street Co-op, 1984




                         20
Project Amik, 2003




                     21
Question???
 We know that housing is one of key
 determinants of health…and that
 housing cures homelessness…and we
 have plenty of housing successes…

 So, why a homelessness disaster
 and affordable housing crisis?

                                   22
Dr. Ursula Franklin

  “Homelessness
  is a man-made
  disaster”.




                      23
What those men did. . .
  Federal:
    1984 to 1993 – almost $2 billion cut from spending
    1993 – all new housing spending cancelled
    1996 – transfer housing to provinces / territories
  Ontario:
    1995 – all new housing spending cancelled
    1995 – welfare rate cuts
    1998 – housing downloaded to municipalities


                                                   24
Turning it around. . .
  The One Percent Solution
  $2 billion for a fully-funded
  national housing strategy
  $2 billion from the provinces
  and territories




                                  25
Comprehensive strategy
  New social housing – 20,000 to 30,000
  new units
  Supportive housing – 10,000 new units
  Rent supplements – 160,000 new units
  Shelter and services for the homeless
  Renovation funding


                                      26
Housing / homelessness gains
  Supporting Community Partnerships Initiative and
  federal homelessness strategy (December 1999)
  Residential Rehabilitation Assistance Program
  (December 1999 and federal budget 2003)
  Federal Surplus Real Lands for Homelessness
  Program (December 1999)
  Affordable Housing Framework Agreement
  (November 2001 and federal budget 2003)
  Layton budget bill (June 2005)
  Extension of SCPI and RRAP (November 2005)


                                                     27
Growing federal commitments
                        Average annual funding commitments

$1,400,000,000
$1,200,000,000
$1,000,000,000
 $800,000,000
 $600,000,000
 $400,000,000
 $200,000,000
           $0
                 1998    1999      2000      2001   2002   2003    2004   2005   2006   2007

                                Aff. Hsng.   SCPI   RRAP   Lands   NDP

                                                                                          28
NHHN grades efforts as “failure”
  “Federal, provincial and territorial housing ministers
  made an impressive 336 announcements since they
  signed the Affordable Housing Framework
  Agreement in 2001 and agreed to invest $1.36 billion
  over five years.
  “That’s a lot of political spin, but it hasn’t produced
  many new homes. Ministers have made promises,
  signed agreements, issued announcements and
  called press conferences. But they have failed to
  build new homes.
  “That’s why the National Housing and Homelessness
  Network has graded federal housing efforts over the
  past four years as a failure.”

                                                       29
Promised vs. delivered
 Fiscal year              Ontario promised:                        Ontario actually delivered:
     ending    (number of new homes announced by federal and   (number of new homes committed as reported
                              Ontario governments)                          in audited statements)



 2002                         9,800                                             22
 2003                       13,912                                              23
 2004                       22,620                                              18
Total                       46,332                                              63


                                                                                                    30
In summary. . .
1. Government cuts in the 1980s and
   1990s are key factor in increased
   housing insecurity and homelessness
2. Effective policy / advocacy work has
   reversed cuts, but emerging
   patchwork doesn’t add up to fully-
   funded, comprehensive program


                                      31
Working towards our goal




                           32

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Housing and Health: Making the Connections, Taking Action

  • 1. December 8, 2005 Housing and health: Making the connections, taking action Michael Shapcott, Senior Fellow Wellesley Central Health Corporation 1
  • 2. What do we know. . . 1. Lack of good quality, affordable housing affects health homelessness, insecure housing higher morbidity and higher motality 2. Subsidized housing is key factor in helping the homeless become housed housing housed 2
  • 4. The Bruce Report (1934) A study of Toronto’s slum districts at the depths of the Great Depression: “These areas of misery and degradation exert an unhappy environmental influence upon many of our citizens.” Dr. H.A. Bruce, Lieutenant-Governor of Ontario 4
  • 5. Housing and health (1984) “Inadequate accommodation is not sole solution to health problems among Toronto’s poor, but being homeless or living in unaffordable or substandard housing makes it difficult, if not impossible, to engage in many practices that promote health. Moreover, inadequate housing foster stress which lowers physical resistance to disease and exacerbates pre-existing emotional strains.” Housing and Health: Public Health Implications of the Crisis in Affordable Housing, Toronto Department of Public Health, 1984 5
  • 6. Homelessness and health “Specific health effects of homelessness and underhousing are difficult to separate from often- associated effects of poverty, unemployment, pre- existing mental and physical disabilities, and age- related vulnerabilities in children and the elderly. . .” “The health effects of homelessness include: cold injury [hypothermia and frostbite]; cardio-respiratory disease [coronary artery disease, high blood pressure, emphysema] tuberculosis; skin problems [infected and ulcerated lesions]; 6
  • 7. Health effects of homelessness nutritional disorders [leading to a greater risk for infectitious diseases, gastrointestinal disorders, skin disease and nervous system dysfunction]; sleep deprivation [leading to instability, emotional irritability, concentration deficits, cognitive impairment, apathy and behaviour disorders]; children’s mental health disorders [leading to developmental lags, anxiety, depression, learning difficulties]; adult psychiatric disorders; and chronic stress [including insomnia, anxiety, depression, loss of self-esteem and withdrawal].” Public inquiry into homelessness and health, 1987 7
  • 8. Morbidity and mortality “Homeless women and men do not have ‘different’ illnesses than general population. However, their living circumstances and poverty affect their ability to cope with health problems.” - Street Health Report, 1992 Homeless women and men have mortality rates 8 to 10 times higher than housed women and men - Dr. Stephen Hwang 8
  • 9. Bed bugs. . . “The rise of bed bugs is a concern for many reasons. First, the nocturnal blood-sucking habits of the bugs induce anxiety, worry, stress, and sleeplessness for those infested. The initial bite, though usually painless, may develop into a welt that remains itchy for weeks. With scratching and subsequent infections, these welts can develop into severe skin conditions. 9
  • 10. …a biological indicator “Bed bugs may be a biological indicator of changing social conditions and might foretell the resurgence of other ectoparasites such as lice and fleas and their associated diseases.” Dr. Timothy Myles , Bed bugs in Toronto, Research Bulletin #19, Centre for Urban and Community Studies, University of Toronto, 2003 10
  • 12. Homeless families in NYC Predictors of Homelessness Among Families in New York City: From Shelter Request to Housing Stability American Journal of Public Health Volume 88(1), November 1998, pp.1651 to 1657 12
  • 13. Method 568 homeless and housed poor families First interviewed in 1988, then interviewed again in 1993 Questions: Who was stably housed (> one year)? Why were they stably housed? 13
  • 14. Factors not affecting stability NOT – race, age, pregnancy, persistent poverty, education, work history, marriage, teen motherhood, child poverty, mental illness, substance use, physical health, incarceration, social ties domestic violence, childhood disruptions 14
  • 15. Who was stable? 80% of families who went into subsidized housing 18% of families who went into unsubsidized housing 15
  • 16. Only factor affecting stability Subsidized housing Marybeth Shinn: “Subsidized housing is both necessary and sufficient to ‘cure’ homelessness among families.” 16
  • 17. Housing succeeds. . . “We found that subsidized housing succeeds in curing homelessness among families, regardless of behavioral disorders or other conditions. Whatever their problems – substance abuse, mental illness, physical illness or a history of incarceration – nearly all of the families became stably housed when they received subsidized housing.” 17
  • 20. Oak Street Co-op, 1984 20
  • 22. Question??? We know that housing is one of key determinants of health…and that housing cures homelessness…and we have plenty of housing successes… So, why a homelessness disaster and affordable housing crisis? 22
  • 23. Dr. Ursula Franklin “Homelessness is a man-made disaster”. 23
  • 24. What those men did. . . Federal: 1984 to 1993 – almost $2 billion cut from spending 1993 – all new housing spending cancelled 1996 – transfer housing to provinces / territories Ontario: 1995 – all new housing spending cancelled 1995 – welfare rate cuts 1998 – housing downloaded to municipalities 24
  • 25. Turning it around. . . The One Percent Solution $2 billion for a fully-funded national housing strategy $2 billion from the provinces and territories 25
  • 26. Comprehensive strategy New social housing – 20,000 to 30,000 new units Supportive housing – 10,000 new units Rent supplements – 160,000 new units Shelter and services for the homeless Renovation funding 26
  • 27. Housing / homelessness gains Supporting Community Partnerships Initiative and federal homelessness strategy (December 1999) Residential Rehabilitation Assistance Program (December 1999 and federal budget 2003) Federal Surplus Real Lands for Homelessness Program (December 1999) Affordable Housing Framework Agreement (November 2001 and federal budget 2003) Layton budget bill (June 2005) Extension of SCPI and RRAP (November 2005) 27
  • 28. Growing federal commitments Average annual funding commitments $1,400,000,000 $1,200,000,000 $1,000,000,000 $800,000,000 $600,000,000 $400,000,000 $200,000,000 $0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Aff. Hsng. SCPI RRAP Lands NDP 28
  • 29. NHHN grades efforts as “failure” “Federal, provincial and territorial housing ministers made an impressive 336 announcements since they signed the Affordable Housing Framework Agreement in 2001 and agreed to invest $1.36 billion over five years. “That’s a lot of political spin, but it hasn’t produced many new homes. Ministers have made promises, signed agreements, issued announcements and called press conferences. But they have failed to build new homes. “That’s why the National Housing and Homelessness Network has graded federal housing efforts over the past four years as a failure.” 29
  • 30. Promised vs. delivered Fiscal year Ontario promised: Ontario actually delivered: ending (number of new homes announced by federal and (number of new homes committed as reported Ontario governments) in audited statements) 2002 9,800 22 2003 13,912 23 2004 22,620 18 Total 46,332 63 30
  • 31. In summary. . . 1. Government cuts in the 1980s and 1990s are key factor in increased housing insecurity and homelessness 2. Effective policy / advocacy work has reversed cuts, but emerging patchwork doesn’t add up to fully- funded, comprehensive program 31