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We don't need more studies on homelessness and health -- we need action

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Advocates on homelessness hold a banner outside the mayor's office in Toronto.

Over the years big money, at least according to my standards, has gone to academics and health researchers who examine the social determinants of health. For 30 years, I’ve studied their work and quoted from their articles and reports. I believe them. Poverty, lack of housing or shelter, racism, unemployment or low wages negatively impact on health and increase the chance of an early death.

The first piece of research I was ever involved in was the 1992 Street Health Report. It was a qualitative piece of work that was acknowledged as solid nursing research by the World Health Organization. It was the first Canadian snapshot of the impact of homelessness on health. It was published before the widespread use of the Internet however it is scanned and on my website.

What’s significant about the 1992 Street Health Report is that the experts were not the researchers; it was the participants who were homeless.

They said:

"The right to healthy and secure rest should be guaranteed to every being on the planet, just like food and air."
- A young man in his 30s, interviewed in a hostel.

"If you don’t have a foundation, you have a house that tumbles. You have homelessness and fear. You have fear that the law will pick you up as a vagrant." 
- A woman in her forties, interviewed in a hostel.

"I got frostbite this year because I had no place to go and I was walking all night." 
- A young man in his 30s, interviewed in a hostel.

"The hardest part of being on the street (not in a shelter) is that it takes away your self respect and confidence. You're constantly lining up for a meal, sleeping with your clothes on, trying to look decent." 
- A man in his 30s, interviewed in a soup kitchen.

"Living on the streets you learn there is lots of prejudice in the medical world against you. You don't have the same rights as everyone else." 
- A man in his 40s, interviewed at a meal place.

"The hardest part is maintaining your emotional stability, because you're not getting anywhere. Your self esteem goes down the tubes." 
- A young man in his 30s, interviewed in a shelter.

"Sexual harassment happens almost every day."
- A young woman, interviewed in a shelter.

Today, twenty-five years after the Street Health Report was published, amidst a worsening homelessness crisis that was declared a disaster in 1998, the gap between research and action could not be greater. In fact, the 30 and 40-somethings from the interviews, if they did not find affordable housing are probably dead, their name inscribed on the Toronto Homeless Memorial.

Here is my snapshot for today:

There is no "Declaration on the Right to Shelter in Toronto," or perhaps anywhere in Canada. In Toronto no right to shelter means that anywhere from 500-1,000 people remain shelterless, relying on volunteer Out of the Cold programs or overnight drop-ins that are really warming centres not real shelters.

The City allows or applies these bandaid measures in the winter only, essentially saying, "Spring, summer, fall -- you’re on your own," and people are. They are forced to sleep and live outside on sidewalks, in parks and ravines, under bridges, in abandoned buildings or cars. To make matters worse, they are ticketed, fined or evicted from those locations by city workers, including police.

Toronto shelters remain well beyond the recommended 90% capacity leading to disease, violence and undue stress. Case in point: Seaton House, Canada’s largest men’s shelter, is now entering its 18th month of a Group A Strep outbreak that included an invasive strain that can cause meningitis, pneumonia or worse.

Toronto's mayor, John Tory, has ignored the 16,000-person petition calling for an armoury or a similar facility to open as an emergency, low-barrier emergency shelter. The Mayor and city staff has similarly ignored pleas from respected leaders from organizations that work with homeless people for help on the shelter capacity front. These include Haven Toronto, Sanctuary, Out of the Cold, West Neighbourhood House, Salvation Army, Social Planning Toronto and 30 more.

To add insult to injury, in the midst of an opiate overdose crisis that has crossed the nation, both the fire department and police department of Canada's largest city do not carry Naloxone, the anti-opiate that if used within seconds of arrival can save a life. In a 36-hour period Toronto recently saw 24 overdoses and four deaths.

With Toronto's new Medical Officer of Health, Dr. Eileen de Villa, one could be hopeful. This week Toronto Public Health released a glimpse of the homeless death data they are collecting. The numbers are shocking: 46 people died while homeless between January and June of this year. That number now surpasses Toronto stats for death by homicide or in traffic accidents. The average age of a homeless person's death is 50. That’s 30 years younger than the Canadian average. Shocking, but it confirms all the social determinants of health research.  

What's more alarming is what we're not being told, what is being contemptibly held back by Toronto Public Health until the one year mark of the research in 2018. This includes: What was the gender breakdown of deaths, how many were youth, what were the medical causes of death, how many were suicides, how many were overdoses, how many were traumatic deaths such as hypothermia, how many occurred outside or in a shelter or hospital? So much information collected by the city that could guide solutions today but no, the gap between research and action just widens.

One has to wonder if it’s ethical to not release data when there is such widespread concern but perhaps more frightening, who is influencing the decision to stay silent and why?

As we wrote in the Toronto Disaster Relief Committee’s State of Emergency Declaration in 1998, "homeless people have been studied to death."

It's now time for action. 

Image: Ontario Coalition Against Poverty

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