Canadian Doctors Call For Action On Healthy Housing

As the Canadian government takes the first steps to develop a national housing strategy, many organizations are stepping forward to emphasize the importance of housing on physical and mental health.

"Experts in health care are trained to focus on the provision of health care services, often sending patients back into the social and economic conditions that made them sick. Nowhere is this more evident than in the case of individuals experiencing homelessness or living in unsafe, precarious housing," wrote family physicians Danyaal Raza and Ritika Goel in a recent commentary.

"We treat chronic back pain and send people back to sleep on concrete steps. We treat insomnia and send people back to chaotic shelters where they cannot sleep. We treat asthma and send people back into mouldy homes where they labour to breathe. We send patients back to the very places that create their disease."

The authors say that 1.5 million Canadians live in housing that is "inadequate, unsuitable and unaffordable. In other words, 1.5 million families live in housing that requires major repairs, does not have enough bedrooms for their needs and pay more than 30 per cent of their household income for this unfit housing."

As a national housing strategy is developed, "housing must be viewed as a health and social justice issue. Safe, secure and affordable housing is crucial to maintaining and improving health and well-being," say Raza and Goel.

A 2013 article in the Ontario Medical Review for the Ontario Medical Association by Kathryn MacKay and John Wellner says, "There is a growing body of evidence that associates housing quality with morbidity from infectious diseases, chronic illnesses, injuries, poor nutrition and mental illness. Sub-standard housing that is damp, mouldy, too hot or too cold is an established contributor to morbidity and mortality as well. Respiratory infections, asthma and activation of tuberculosis have been independently associated with such housing conditions. Overcrowding can also increase susceptibility to disease."

In a position statement, The Canadian Paediatric Society says, "Compared with peers living in adequate housing conditions, children and youth living in inadequate and crowded housing exhibit a number of negative outcomes, including aggressive behaviours, property offences, diminished school performance, asthma symptoms and diminished overall health status. Other studies link inadequate housing with poor air quality and lead exposure, an increased risk for asthma and exposure to health hazards and injury risks."

The society says children and youth who feel they live in an unsafe neighbourhood experience higher rates of anxiety disorders and it can limit the amount of time they spend doing outdoor physical activity.

"Paediatricians and other physicians caring for children are uniquely qualified to advocate for enhanced action from all levels of government for housing-supported policies," says the position paper. "However, they also need to collaborate within the health care system, work with other sectors caring for children and youth, and engage with organizations involved in building community and housing support."

A new study being funded by Canada Mortgage and Housing Corp. is examining whether people who receive rent geared to income RGI housing for the first time "experience any impact on mental health, general health and other known determinants of health, such as social support, sense of community, health behaviours or on income and education," says a research report by the studys principal investigator, James Dunn of St. Michaels Hospital in Toronto.

He says the study, which will run until March 2019, "is a strong study design that improves on many other studies of housing and health by ensuring that the direction of causality between housing and health is correct. In other words, previous cross-sectional studies that showed >

Dunn says it is well-established that "low-income individuals often compromise or discount their own health in order to pay for housing." They may not buy a full course of prescription drugs that they should take, or they will buy less healthy foods and avoid medical treatment until their problems become worse.

More that half of those applying for RGI housing are moving from an apartment they cant afford.

The study group is a "low-income, but fairly well-educated population who report a high level of satisfaction with their current housing and who also have somewhat poorer mental and general health than the general population, reflecting their low-income status," says the researcher.

"Follow-up data collected from all participants at six, 12 and 18 months after they receive RGI housing will help to quantify impacts that affordable housing has on the health status of participants," it says. "This comparison will help determine if the provision of affordable housing has an impact on general health, mental health and known determinants of health."

Its hoped the results from the study will "help inform the development of future housing policies and programs."