In emergency rooms and front-line clinics, patients are triaged based on the urgency of their illness. The sickest are seen first, followed by those in less immediate danger. A high-quality health system would connect these efforts to a larger plan to prevent illness and keep people healthy, but still make sure help is there in a hurry when things go wrong.
Unfortunately, in Canada, we aren't there yet.
One of the biggest factors that determines whether people will stay healthy or wind up needing emergency or chronic medical care is where they live. People without access to stable housing are at higher risk of illness, and their likelihood of recovering well from that illness is greatly diminished.
How bad is Canada's housing crisis?
"Homelessness causes premature death, poor health and is a significant burden on our health-care system."
According to the newly released National Shelter Study, Canada's emergency shelters are packed to the rafters. People are languishing in homelessness longer, and their ranks include seniors, veterans and families with children. Shamefully, Indigenous Canadians are more than 10 times more likely than non-Indigenous people to end up in emergency shelter.
This report paints only a partial picture of homelessness in Canada, including only emergency shelters.
The sad reality is that more than 35,000 Canadians are homeless on a given night, with more than 235,000 Canadians experiencing homelessness at some point every year, whether they sleep in shelters, on the street, couch surf or wait unnecessarily in a hospital or other temporary accommodation.
Beyond a crisis of housing and poverty, homelessness is a public health emergency. The longer people are homeless, the worse their health becomes. A recent report from British Columbia suggests life expectancy for people experiencing homelessness in that province is roughly half that of other British Columbians.
Some physicians have gone so far as to label homelessness a palliative diagnosis. Not having a home can be lethal. Homelessness causes premature death and poor health and is a significant burden on our health-care system.
Crisis could get worse
Today more than 1.5 million Canadian households live with core housing need, with more than half of those households living in extreme core housing need (living in poverty and spending more than 50 per cent of their income on housing).
The crisis stands to get worse before it gets better, as federal operating agreements for older social housing expire and more than 300,000 more households risk losing the subsidies that keep their housing affordable.
From 1988 to 2013, Canada's population grew more than 30 per cent, but federal funding for affordable housing has dropped more than 46 per cent in the past 25 years, York University's Homeless Hub reports. At least 100,000 units of affordable housing were not built because of the cancellation of funding programs for affordable housing, the report says.
Canada's homelessness crisis is the direct result of this federal withdrawal from housing investment.
The new federal government has promised a national housing strategy, and has begun consultations. "The Government of Canada believes that all Canadians deserve access to housing that meets their needs and that they can afford," the federal government's Let's Talk Housing website says.
Solving all of Canada's housing problems at once, from homelessness to the rising cost of home ownership, would be wonderful. It is absolutely the right objective, but the sheer scale of the challenge when set against political and fiscal realities will force the government to make some difficult choices — something Canada Mortgage and Housing Corp. president and CEO Evan Siddall acknowledged in media interviews recently.
All Canadians deserve safe, decent and affordable housing, but for some, the lack of housing is a matter of life and death. To make the difficult choices ahead, the government should take a page from medicine and triage.
What needs to be done
The most pressing problem — finding stable housing for those who are currently homeless or at risk for homelessness — is one that, fortunately, can be solved.
We need to start by collecting real-time, person-specific data on homelessness and expanding the application of the Housing First model of supportive housing for individuals with greater challenges. Housing First is an evidence-based approach to ending homelessness that provides direct access to permanent housing and support.
"Canada's homelessness crisis is the direct result of this federal withdrawal from housing investment."
Add to this better co-ordination in local planning, targeted investment in affordable rental housing and a national housing benefit, and homelessness in Canada could become rare, brief and non-recurring.
Not only would this take care of those most in need, it would also make more funds available to address elements of our housing challenges that lie further upstream. The cost savings from shelters and emergency rooms could later be applied to the next steps: providing more affordable social housing and preventing more people from falling into homelessness.
In building a national housing strategy, we can build a future when all Canadians have access to safe, decent and affordable housing. The first step to reaching that goal is urgent action to house Canadians experiencing or at risk of homelessness.
Tim Richter is the president and CEO of the Canadian Alliance to End Homelessness, a national movement of individuals, organizations and communities working together to end homelessness in Canada.
Ryan Meili is a family physician in Saskatoon, an expert advisor with Evidence Network and founder of Upstream.
Cover photo by John Bonnar from National Housing Day in Toronto, 2015.