'Vulnerably housed' people have same severe health problems as homeless people

St. Michael's HospitalNov 20 2010

Both groups suffer same health problems, poor diet and barriers to health care

For every one person in Canada who is homeless, another 23 live in unsafe, crowded or unaffordable housing, meaning the country's housing crisis is even worse than previously thought, according to Dr. Stephen Hwang of St. Michael's Hospital in Toronto.

Those "vulnerably housed" people have the same severe health problems and dangers of assault as homeless people, said Hwang, principal investigator of a new report on housing and health issues in Vancouver, Toronto and Ottawa.

"The key point is that Canada needs a national housing strategy," Hwang said. "We all recognize that health care is important for good health, and so we have universal health care. Decent and affordable housing is just as essential for good health."

The report, "Housing Vulnerability and Health: Canada's Hidden Emergency," will be released Nov. 19 in Ottawa at the annual research forum of the Alliance to End Homelessness in Ottawa. It contains startling new data from the first Canadian study to chart the changes over time in the health and housing status of the homeless and vulnerably housed and the first to compare their health outcomes.

There is no accurate count of the number of homeless people in Canada, because so many are hidden or sleep on the streets or friend's couches. In 2005, the federal government estimated there were 150,000 homeless Canadians, or about 0.5 per cent of the population, although homeless advocates have always said the number was much higher.

The report by Hwang's group notes there are 17,000 shelter beds regularly available across the country. But, for each person staying at a homeless shelter, there are another 23 people -- about 400,000 across Canada -- who are vulnerably housed and at risk of becoming homeless, meaning they had a place to live, but it was in bad condition, crowded, unsafe or cost more than 50 per cent of their income.

"Before now, researchers and decision-makers have often thought of these groups, the homeless and the vulnerably housed, as two distinct populations, with two different levels of need," Hwang said. "This study paints a different picture."

According to the report, both groups of people share the following problems:

• Chronic health conditions such as arthritis (33 per cent), Hepatitis B and C (30 per cent) and asthma (23 per cent)
• 38 per cent have been assaulted in the past year
• 52 per cent have been diagnosed with a mental health problem
• One in three has trouble getting enough to eat
• 38 per cent cannot get the health care they need
• 55 per cent visited an emergency department in the past year

In the next phase of their study, the researchers will undertake the first study in Canada to discover how often homeless people get housing and stay housed, and how often the vulnerably housed become homeless - and the health implications of these changes. If the vulnerably housed become homeless, do they use health care more and does their health deteriorate, and if the homeless find homes does their health improve and health care use decrease?

Hwang is a physician in the Centre for Research on Inner City Health at St. Michael's. He leads a group called the Research Alliance for Canadian Homelessness, Housing, and Health (REACH3), which includes some of Canada's leading academic researchers and community organizations with expertise on homelessness. The study of longitudinal changes in the health and housing status of 1,200 homeless and vulnerably houses single adults in Vancouver, Toronto and Ottawa is one of REACH3's projects and is known as the Health and Housing in Transition (HHiT) study.