Having spent a lot of my time in the past year and a half working with patients who are homeless or marginally housed, I thought I would post some thoughts on homelessness here in the blog. Homelessness is a complex problem and I don't believe I have any magical answers to the issue. I do believe that dialog is a starting point for complex issues however, and hope that posting about the issue raises the level of the dialog that is going on.
In any dialog it is important to define terms of reference up front. In 1996 at the second HABITAT conference in Istanbul the UN member states present agreed on a definition of housing: "Adequate shelter means more than a roof over one's head. It also means adequate privacy; adequate space; physical accessibility; adequate security; security of tenure; structural stability and durability; adequate lighting, heating and ventilation; adequate basic infrastructure, such as water-supply, sanitation and waste-management facilities; suitable environmental quality and health-related factors; ..." This definition highlights the fact that a home is not only a structure, but also offers saftey, privacy, and basic (culturally appropriate) utilities, and that these features are durable over time. Another important concept in the discussion is the concept of near-homelessness. Near-homelessness defines those people who are in danger of becoming homeless, typically those who would be homeless if they missed one paycheck. An example of near-homelessness would be a family who would be unable to pay for shelter if one parent missed a single paycheck (for example due to illness). In fact, a discussion of homelessness is not only a discussion of those who are unhoused, but also of those who are inadequately, and marginally housed.
One long-term patient of mine who had been homeless and living outdoors for over a year framed the problem as a classic Morton's Fork type of choice (a choice between two equally unpleasant alternatives): "The real choice," he told me, "is to live outside in the rain, or to live inside with the bedbugs." His observations of the reality of low income housing in Vancouver highlight how homelessness and inadequate housing are intertwined. In British Columbia a single adult person on social assistance recieves $325 per month for housing costs. The type of housing this typically provides is in a single room occupancy hotel (or SRO). An SRO is typically a multi-floored hotel type of housing. Each unit typically consists of one room, off of the main hall with a locking door. Individual rooms may have a sink, and a hotplate for cooking, and rarely have a private toilet or shower. Usually the toilet and shower are located at the end of the hall, and shared by the tenants of each floor. Although there are well maintained SROs in Vancouver, this is not the norm. Many SROs have problems with ongoing infestations with insects (especially bedbugs) and rodents. Many are inadequately maintained, and have frequent issues with heating, electricity, and problems with water pipes. Many have poor security. Many rooms have inadequate locks, and many buildings have little front door or front desk security. It is not unusual for drug-dealers to 'take over' a room on a floor of an SRO in order to ensure monopoly on illicit drug sales on that floor. Typically the room taken over is of someone who is percieved as an easy target, elderly, or ill. Clearly many SRO type residences would fail to meet the UN definition for housing.
Many of the persons who live in SROs are living there marginally, paying for their stay with social assistance that is at risk of being cut off, and at risk of eviction due to condemnation, remodelling, or closure of the hotel itself. For those who are homeless, housing really can be a choice between the devil and the deep blue sea; to live outside in Vancouver's rain, or to live inside in inadequate conditions, with the looming threat of return to the streets. The issue is not as simple as closing SROs. In fact SROs, as inadequate as they often are, provide the majority of basic affordable housing in downtown Vancouver. The affordable housing that exists is not nearly adequate for demand and it can be very difficult to find vacancy in an SRO in Vancouver, especially in winter.
The homelessness issue in Vancouver is growing. In my own experience working in a Community Health Clinic on the Downtown Eastside it was normal to see new homeless patients come in to the clinic most days. Some of these patients were new to Vancouver from other parts of BC or Canada, and some were long-time Vancouver residents who had lost their housing. The 2005 Vancouver Homeless Count provides an estimate of the number of homeless people in Vancouver. Although there are flaws with the design of the count, and although it probably underestimates homelessness, it does show that the number of homeless is on the rise. In 2002 the count enumerated 1121 homeless persons, in 2005 the count was 2174. The count also highlights the diversity of the homeless population: women, men, youth, seniors, first nations, and families. Only 45% had any steady income or were on social assistance. Seventy-four percent reported a chronic medical condition, and almost 50% had addiction problems.
The data from the Vancouver Homeless Count fits well with what I have observed over the past year and a half working in the Downtown Eastside. Homelessness is growing, and there are new homeless people on Vancouver's streets every day. The homeless population diverse, and includes many groups not traditionally considered in the discussion of homelessness. There is a lack of good, and affordable housing in Vancouver, and the near-homeless and marginally housed vastly outnumber the homeless, though they experience many of the same problems. Homelessness causes medical problems, and makes existing medical problems worse. In my experience living outdoors makes problems with addiction, mental illness and serious diseases like HIV/AIDS much worse.
The issue of homelessness in Vancouver is complex, and growing. As costs of living in Vancouver, housing prices, and rental rates continue to climb we continue to see widening of the disparity between rich and poor. In my opinion we should be looking at root causes of homelessness, determining risk factors for future homelessness and addressing these early. We should be looking at ways to help people currently struggling with homelessness, near-homelessness and inadequate housing, by developing stratagies that address transition away from homelessness through addressing the disparities that result in homelessness in the first place. Addressing addiction, mental illness, physical illness (especially HIV/AIDS), addressing the causes of baseline poverty, and providing support to specific groups of homeless persons such as women fleeing violence, first nations persons, refugees and imigrants to Canada, and persons discharged from the prison system all play a part in addressing the issue of homelessness.
Vancouver is facing a difficult crisis, and based on the data available the problem seems to be getting worse. We need to have an open and honest dialog about this issue, and to look at new and creative solutions if we are going to move forward and towards real solutions.
If this issue interests you, check out homelessnation.org a site where real people struggling with homelessness give their perspective on the issues.