Fifteen years ago a report on Toronto's homeless was published by Street Health, a community-based health care organization working with homeless and under-housed people in the city's downtown area. The first of its kind in North America, the 1992 report's gruesome statistics revealed a pattern of increased health risk, poor access to health care, exposure to violence, and general despair. The intervening years have been nothing short of brutal for homeless people, although the means have existed to improve their situation. While the exact number of street dwellers has been difficult to estimate, the current estimate is that about 6,500 people slept in shelters last year on any given night, a tripling of the homeless population since the early 1990s.
Released in September, Street Health Report 2007 presents the latest findings on the state of homeless adults in Toronto. The study was conducted in the winter of 2006/2007. There are few surprises. The news is terrible:
Overall, homeless people in Toronto have much poorer health than the general population. Homeless people in our survey carry an alarmingly higher burden of many serious physical and mental health conditions. Three quarters suffer from at least one chronic or ongoing physical health condition. In the past year, more than half had experienced serious depression and one in ten had attempted suicide.Quoted in a Toronto Star article, Kathy Hardill, outreach nurse and an author of the original study, says the decreased access to health care is one of the study's most shocking findings — especially given the prevalence of disease and disability among Toronto's homeless. Diabetes has increased threefold since 1992; 43 per cent have arthritis, up from 29.8 per cent; and 23 per cent have hepatitis C. In a brief news article, the CMAJ (6 Nov 2007) comments: "It paints a grim picture."
The health of homeless people in Toronto has deteriorated in the past 15 years. Many serious physical health problems have become more common, and new illnesses have emerged that disproportionately affect homeless people. The most important factors impacting the health of homeless people are the result of social policy decisions that have been made by our governments in the past 15 years, particularly the cuts to social assistance and the lack of investment in new affordable social housing.
Homelessness is a devastating and growing problem in Toronto. There is an urgent need to take action to:• Address the poverty and inequality that underlies homelessness• Improve access to affordable and appropriate housing• Improve immediate living conditions for homeless people• Improve access to health care and support for homeless people
The Street Health Report concludes with an action plan consisting of realistic solutions to immediately improve the health of homeless people and to ultimately end homelessness. Among its 13 recommendations:
- Increase social assistance rates;
- Raise the minimum wage to $10 per hour immediately;
- Increase the availability of affordable housing as soon as possible.