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Hook’s guest blogger covers big urban health conference media largely ignored

I am a writer and communications operative who specializes in public health and environmental issues. This week, I’ve been milling around the ballrooms and palatial foyers of the Westin Bayshore Resort and Marina, along with 500 other delegates at the 7th International Conference on Urban Health.

Last week, I volunteered some time to help publicize the conference, which focuses on successful interventions and the latest research on many of the gritty issues that plague Vancouver (and cities everywhere). In advance of the civic elections, I thought it would be easy to attract a few reporters, but I was wrong as the media have by and large ignored the event.

So, over the next week here on The Hook, I will blog about what they missed.

First, yesterday’s talk on homelessness.

Homelessness is a health problem. Or so goes the argument which has prevailed in British Columbia and much of Canada for the last 20 years.

It’s a symptom of drug dependence, mental illness and other complex conditions that must be addressed, first of all, by health authorities – building new facilities, providing drug treatment beds, and so on.

People who study homelessness will tell you that there is truth in this, but add that it’s a sneaky argument. Why? Because it has allowed governments to shirk their responsibility for affordable housing – as the federal government did in the 1980s, before downloading it to the provinces in the 1990s.

And it’s an argument that is exploded by new research from one of Canada’s first multi-year (longitudinal) studies of homelessness, presented at the conference Thursday, October 30.

The Panel Study on Homelessness in Ottawa, which ran from 2002-2005, set to out to clarify, among other things, what helps and hinders different groups of homeless people in finding stable housing (For a full report, go here.)

Led by two professors from Carleton University and the University of Ottawa, Fran Klodawsky and Tim Aubry, the study team initially interviewed 412 homeless people in city shelters, and, two years later, managed to interview 255 of them once again to assess their progress.

The cohort for the second interviews included 43 single men, 55 single women, 49 male youth, 50 female youth, and 58 adults in families. One in four were immigrants or refugee claimants.

Among the foreign-born group, the majority had been in Canada for more than two years, and these respondents cited financial troubles, family conflict, and problems related to their refugee status as the main reasons for their homelessness. Unlike Canadian-born participants, few blamed health problems or substance use.

Ottawa’s foreign-born homeless people – Somalis and others from sub-Saharan African countries are over-represented – also tended to be better educated and more likely to have large families in tow, compared with Canadian-born study participants. Some 30 of the 78 foreign-born participants had university degrees or some post-secondary education.

The two sub-groups, however, showed a striking similarity: both had equal difficulty in finding stable housing.

And when the researchers sliced their data in a different way, they found the same thing.

After controlling for various factors, they found that four groups of participants categorized according to health status – high functioning (29%); substance users (27%); substance users with mental illnesses (23%); and people with severe and complex health problems (22%) – had equal difficult in finding stable housing and experiencing repeated bouts of homelessness.

Based on their findings, the Ottawa study identified predictors of whether a homeless person will find stable housing: for example, demographic factors and the person’s housing history and sense of empowerment.

But the two most salient predictors were access to subsidized housing and level of income.

“Economic factors trump health status,” concludes principal investigator Tim Aubry. “This is just one city, and homeless populations differ greatly between cities, but across Canada poverty remains the main driver of homelessness – so we need concerted anti-poverty policies to address the problem.”

The federal government must develop a national housing strategy.

And though that may not be a priority of the Harper government, provincial and local authorities are beginning to take action. In B.C., the provincial government has bought up old hotels and promised more social housing. Toronto’s Streets to Homes initiative has, since 2005, provided stable housing for 2200 previously homeless street people – of all health profiles.

The demographics of B.C.’s homeless population are different from those of Ottawa but the study is very relevant to the West Coast, says Professor Jim Frankish, Director of UBC’s Centre for Population Health Promotion Research.

There are upwards of 1,800 homeless people living on the street in Vancouver; Ottawa’s roughly 9,000 homeless tend to stay in city shelters. B.C.’s homeless are mostly Canadian-born, with 20-30% from aboriginal communities. Foreign-born homeless people in B.C. tend to be “hidden” – couch surfing or crowding into the houses of family members.

Frankish estimates that 2,000-3,000 homeless people in Greater Vancouver live in shelters, and an increasing number of these people hold down menial daily jobs.

He notes that studies have shown that after controlling for other predictors such as de-institutionalization of mentally ill people, lack of affordable housing is the main reason for people remaining without a roof over their heads.

As Frankish quips, “There’s a joke in our field, which sums it up: the solution to homelessness is homes.”

For more on homelessness in B.C., go to here.

Jim Boothroyd was spokesperson for the NAOMI project conducting prescribed heroin trials in Vancouver, and researches and writes for the World Health Organization and others. The views expressed here are his own.

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