Health Inequities in Canada: A P ublic Health Epidemic

1. Health Inequities in Canada:A Public Health Epidemic Dr. J. Frankish, Professor & Director Centre for Population Health Promotion Research College of Interdisciplinary Studies School of Population & Public Health‘The price of housing in Vancouver for the homeless or poor & most young people is 'beyond Hope'.

2. Homelessness – Related Projects • Health Services Mental Illness & Homelessness • Health Literacy in Street Youth • Initiation of IV Drug Use • Social Construction of Homelessness • Quality of Life in Homelessness • Review of Measures of Homelessness • Urban-Rural Migration & Homelessness • Cost-Benefits of Housing for Homeless • Attitudes Toward the Homeless

3. Which Aspects of HomelessnessAre Societally Acceptable?

4. Why Reduce Inequities ?? • Health inequities are unfair. • Inequities affect everyone. Conditions that lead to, or result from, inequalities are detrimental to all of society. (e.g., infectious diseases). • Inequities are avoidable to the extent that they stem from policies used by governmentsor human behaviour. • Interventions to reduce inequitiesare cost effective. • Inequality erodes social cohesion & impedesproductivity & economic growth. Kawachi 1999

5. The Bottom Line is Health Inequities • Free-market policies slightly raise our average health but do far more to raise health and quality of life in the wealthy. They do not reduce inequities or improve the health of the poor. • Last month, WHO said the most important thing a government can do is to “tackle the inequitable distribution of power, money, and resources”. • We brag that the UN votes us “best country”. The truth is that our wealthy “mask food banks, homeless, and abysmal conditions for First Nations.” • If we want to be healthy as people (and as a country), we should mimic the Scandinavians and ask all parties - “What are you doing to reduce inequalities?”

6. Poverty and Inequality Hurts Children Social Spending and Child Poverty

7. Low Wages and Child Poverty

9. What About Supportive Housing? • 130,000 adults meet the criteria for SAMI. • 39,000 (26,000 - 51,500) of these people are inadequately housed • 26,500 (17,500 - 35,500) lack housing and support • Absolute homeless are 11,750 (8,000 - 15,500). • In BC, there are 7,741 housing units with support for SAMI • 18,759 are at imminent risk of homelessness • For homeless, non-housing service costs are $644 M or > $55,000/yr. • Adequate housing /supports reduces this cost to $37,000/year. This results in an overall ‘cost avoidance’ of about $211 million per year. • Net cost avoidance of $33 M/year in BC w/o indirect costs such as costs to business and tourism, conference and convention bookings, etc. • 2007. Patterson, M. Frankish, J., McIntosh, K. & Shiell, A. Housing & Support for Adults with SAMI in BC

10. State of Current Evidence • Level 1 – Positive Impact on Resident Stability & Decreased Hospitalizations • Level 2 – Limited Evidence of Greater Impacts of Supported Housing over Alternatives • Level 3 – Preliminary Evidence of Reduced Costs with Supported Housing • Level 3 – Preliminary Evidence for Principles of Supported Housing Rog 2004

11. Evidence-Based and Promising Practices • Evidence-based practices Housing subsidies Increasing the supply of permanent affordable housing • Promising practices Rapid Re-housing and Housing First approaches Transition-in-Place housing Prevention strategies Cheryl Bell, HRSA 2006

12. Supportive Housing MayIncreaseUse and Costs • Outpatient primary and specialty medical care • Some mental health services (e.g. case management, pharmacy) • Methadone (more consistent participation) • Services to address substance abuse problems, including services delivered outside of traditional treatment programs • Vocational and employment services • Legal & Probation services

13. Ending Homelessness within Our Grasp “The results of a decade and a half of research to determine what works to end homelessness are fairly conclusive about effective approaches….without housing, virtually nothing else works.” Martha R. Burt – Helping America’s Homeless: Emergency Shelter or Affordable Housing

14. Potential Innovations • Tell the public the truth about health inequities and the true determinants of health. • Scottish Homelessness Act that all homeless people are entitled to permanent housing by 2012. • One Percent Solution is a call for the federal government to commit $2B matched by the provinces & territories. • Britain’s Targets to Reduce Health Inequities By 2010 reduce 10% gap between 1/5 of Health Authorities with lowest lifeexpectancy & the whole population. • Match housing stock to income distributions

15. ‘Unreal’ Estate • Recent RealtyLink in UBC area • 4 houses – minimum $929,000, maximum $7.68 M • 13 townhouses – minimum $458,000, maximum $2.38 M • 57 apartments – minimum $348,000 , maximum of $1.87 M • None of 12,000 employees had a sufficient household income to purchase the average listed house ($3.9 M). • 2% qualify to buy the average townhouse ($1.2 M). • 11% could buy the average apartment ($724,000). •  None of 5,000 unionized people could buy any of the 74 properties. • Frankish, 2008.

16. Matching Housing Stock to Incomes

17. Contact Information • Dr. Jim Frankish, Senior Scholar, Michael Smith FoundationDirector, Centre for Population Health Promotion Research Professor, Interdisciplinary Studies & School of Population & Public Health • Room 425, Library Processing Centre, 2206 East Mall Vancouver BC V6T 1Z3, 604-822-9205, 822-9210, frankish@interchange.ubc.ca • Personal Website: jimfrankish.com, Strategic Training Program – Partners in Community Health Research www.pchr.net