Recently, Rich Coleman, the B.C. Minister Responsible for Housing, made vague announcements to media regarding whether not some programs such as social enterprises led by Portland Hotel Society (PHS) community services would continue. It was also stated that decisions will eventually be made about all of the PHS operations. This is following the now widely publicized resignation of PHS management and board of directors after audits by BC Housing and Vancouver Coastal Health found irregularities in administrative spending.
Now that the dust is slowly settling over the controversial upheaval of management and the trip to Disneyland, Coleman has once again sent gossip of possibilities rippling through the community, as he did when the first news of possible outcomes from the audit was published by The Tyee. The question now circulating is whether certain programs will continue in the long-term as there have so far only been reassurances nothing will change immediately.
The so-called determinants of health
If we knew what contributed to the higher rates of homelessness and illness within the Downtown East Side (DTES) compared to the rest of the population in Vancouver, could we then address it properly? If taxpayers were concerned with the medical and policing costs of the neighbourhood, could we at least identify and start to address the root problem?
The standard answer to that question is that we do know and we have. It has been established as the complex combination of mental illness and addiction. However, if we were to paddle a little farther upstream, we could then see that mental health and addiction are not alone in a vacuum.
Health and wellbeing in the DTES, as with all communities across Canada, are impacted largely by the so-called social determinants of health. Canadian and international medical and nursing associations, the World Health Organization and other allied health disciplines have all ventured up that extra mile to come to the same conclusion: health is based primarily on socioeconomic status.
Factors such as income, social inclusion, food and job security as well as education, stress, social safety nets and housing, largely determine morbidity and mortality. With public concern regarding the millions spent in services in the embattled Vancouver neighbourhood, the funding that may possibly be the most at risk right now is that which supports programs that try to moderate the impact of these factors.
With the government's inability to raise social assistance rates, end homelessness, provide food security or employment opportunities to those with disability or who have been marginalized by other means, programming which helps to moderate the social determinants of health may be needed more than ever until they can.
Reports have shown that while the evidence is clear that the interaction of economy and public policy largely affects the health of a population, historically, little is done to address this. Many programs currently exist with the knowledge and good faith that if quality of life and opportunity increase, so do peoples' health outcomes. What there is lacking in the DTES may be the structure to measure this and therefore provide the hard data needed to meet bureaucratic mandates.
But how is social inclusion measured in a community facing displacement? Not directly by an individual's lab values drawn from blood work, but lack of spaces which provide this may be just as telling of one's wellbeing.
Failing to accommodate may mean failing to provide
So as these decisions will be left between a health authority and a housing authority, how do the various programs run by the PHS fit into the mandates of either? What are the programs in question?
Although it is debatable how a high-end chocolate shop serves a low-income community, at least one thing that East Van Roasters does offer, along with a laundry service, café, craft store and garden, is opportunity for entry level, flexible work for those who may be discriminated against by other possible employers.
Many who struggle with addiction and mental illness may have to leave the labour market for intermittent or long stretches of time forcing them into poverty. With stigma attached to both of these scenarios, employers are unlikely to be happy with an honest explanation for a gap in employment history. Even less likely, is the chance individuals receive when these conditions continue to be a daily reality.
The Radiostation café was started for this purpose as well as to provide a place to socialize off the street for the many residents of SRO buildings, many which have no common spaces, tiny living quarters, infestations as well as possible no-guest rules.
Beyond social enterprises, other projects such as the Drug Users Resource Centre offer programming outside of the traditional health and housing related services. This centre has reached out to some of the most marginalized by providing innovative harm reduction resources such as beer and wine making classes and drinkers' lounge for those who were previously drinking rubbing alcohol and mouthwash in parks.
Other programming includes activist workshops led by long-time neighbourhood residents, the homeless soccer league and educational classes on how to perform CPR and deliver Narcan to other drug users, friends and loved ones experiencing drug overdose. These programs and others run across the DTES such as drum-making workshops and community sweats, may seem to outsiders as non-essential, but for many working in the DTES, they have been a point of connection with those who have long been institutionalized or neglected by orthodox health and social services.
The spectrum of programming that the PHS has provided, consistently offers reorientation of typical services for a population that has been labeled "hard to serve" or "hard to house." Health care and social programs often look different for this population, as the needs are different. Failing to accommodate this fact may be failing to provide health care to a community.
How do we prove it?
The DTES is a vibrant neighbourhood of many who volunteer and work towards social justice in their community. The PHS is also by no means the only service provider in the neighbourhood, but rather is one of many formal and informal operations trying to improve lives. But, as the more general and systemic problem is our health care system only paying lip service to the social determinants of health, funding for all programs that try to moderate the impacts may be at risk.
Programming which provides nutrition, education, jobs and offers connection to culture and community can have the ability to empower, heal and save lives. Those of us who have the privilege to work in front line positions see this daily. The question now may be how to prove it.
Leila Gold is currently a nursing student working towards her Bachelor of Science in nursing from Langara College and interested in population health and health equity. She has worked for PHS Community Services as a Support Worker for nine years, primarily at Insite, the supervised injection site.
Photo: flickr/Jen Gibson
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