Aboriginal Homelessness: A Vulnerable Population in Canada
During my career in health care, I have observed many vulnerable populations such as the elderly, Aboriginal populations, LGBTQ community, immigrants, homeless, those with HIV as well as those with ongoing mental health issues. This is a short list of vulnerable populations I have personally encountered and I will now focus on discussing one vulnerable group in particular in this blog post. A colleague has inspired me to further investigate the health of homeless Aboriginals in Canada.
Definition of Homelessness
The British Columbia Non-Profit Housing Association & M. Thomson Consulting (2017) cite the following definition of homelessness from the 2012 Canadian Homelessness Research Network as: “the situation of an individual or family without stable, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it. It is the result of systemic or societal barriers, a lack of affordable and appropriate housing, the individual/household's financial, mental, cognitive, behavioral or physical challenges, and/or racism and discrimination. Most people do not choose to be homeless, and the experience is generally negative, unpleasant, stressful and distressing”. An important consideration stemming from this definition is that homelessness is not a choice and usually results from impacts of the social determinants of health.
Aboriginal Homelessness
Urban Aboriginal People experience homelessness at a disproportionate rate and make up a significant percentage of the homeless populations in cities with suggested rates of homelessness 8 times higher than non-Aboriginals (The Homelessness Hub, 2017). Homelessness, however, does not occur equally across all Aboriginal populations (Reading, 2009). Additionally, within Aboriginal groups, girls and young women are over-represented in the homelessness populations of Canada’s cities (Hyslop, 2017) (Patrick, 2014). This issue of multiple burdens on Aboriginal women’s health is discussed in my recent blog post titled “Multilevel Understanding of Health” (March, 2018).
Homelessness has many levels and on a superficial level one may think that it simply means to be without a home. Circumstances of homelessness include the following: unsheltered or absolutely homeless; emergency sheltered; temporary accommodation; and those at risk of homelessness (Patrick, 2014). Jessie Thistle, an executive board member of the Canadian Observatory on Homelessness, consulted with a national advisory committee of Aboriginal scholars and service providers to further define homelessness for Aboriginal Peoples (Hyslop, 2017). His group highlighted unique dimensions of homelessness including: historic displacement from pre-colonial land; spiritual separation from Aboriginal worldviews; mental disruption and imbalance caused by colonization; alienation of Aboriginal People from their culture; overcrowding; relocation for access to services such as health and education; those returning home are often seen as outsiders and those fleeing homes to survive. Consideration of these unique homelessness issues will facilitate an improved cultural understanding of the challenges of homelessness and health of Aboriginal People.
Housing First Initiative
The Housing First initiative is a federally funded project working with several other organizations and communities across Canada that have adopted this approach. Housing First is an effective tool in solving chronic and episodic homelessness while reducing pressure on other emergency services. Permanent housing, complemented by the provision of services, helps to assist clients to sustain their housing and work towards recovery and reintegration into the community (Government of Canada, 2014). This initiative may prove challenging to address the cultural needs of Aboriginal People, especially for those in large urban centres where costs of housing are extremely high and areas where affordable housing is lacking.
Effects of Homelessness on Health
The literature shows that homeless people have higher than average levels of morbidity and mortality and often experience barriers to accessing safe and effective health care and health services (Reading, 2009). Health risks related to homelessness include exposure to the elements, poor nutrition and poor management of chronic diseases. Sleep patterns may be impacted and living without routines and inconsistent access to medical supplies may impact medical conditions. Those who are homeless may not have a consistent health provider and have limited social supports which exacerbate medical conditions. Substandard housing in Aboriginal communities may include overcrowding, poor air quality leading to development of mould and indoor pollution as a result of wood and coal burning stoves and tobacco use (Reading, 2009). All of these issues may impact the respiratory function of the elderly, young children and those with chronic conditions. Patrick (2014) states that homelessness can have a devastating influence on health and reveals larger problems in a person’s life including substance abuse issues, mental health issues, family breakdown, low income and racism.
Homeless Aboriginal People can be better served by:
Improving the understanding of unique causes of Aboriginal homelessness;
Developing and implementing culturally safe Housing First Initiatives;
Ensuring Housing Programs consider on-reserve versus off-reserve housing challenges;
Involving Aboriginal communities directly in housing policy development;
Increasing funding for social housing and mortgage subsidies;
All levels of government working together with Aboriginal communities using a holistic approach to life improvement by improving accessibility to housing programs. (B.C. Non-Profit Housing Association & M. Thomson Consulting)(Government of Canada, 2014)(Hyslop, 2017)(Patrick, 2014).
References
B.C. Non-Profit Housing Association & M.Thomson Consulting. (2017). 2017 Homeless Count in Metro Vancouver. Prepared for the Metro Vancouver Homelessness Partnering Strategy Community Entity. Burnaby, BC: Metro Vancouver. Retrieved March 16, 2018 from http://www.metrovancouver.org/services/regional-planning/homelessness/HomelessnessPublications/2017AboriginalHomelessnessCount.pdf
Government of Canada. (2014). Housing first. Retrieved March 15, 2018 from https://www.canada.ca/en/employment-social-development/programs/communities/homelessness/housing-first.html
Patrick, Caryl. (2014). Aboriginal Homelessness in Canada: A Literature review. Toronto: Canadian Homelessness Research Network Press. Retrieved March 16, 2018 from http://www.homelesshub.ca/sites/default/files/AboriginalLiteratureReview.pdf
The Homelessness Hub. (2017). Indigenous Peoples. Retrieved March 17, 2018 from http://homelesshub.ca/solutions/population-specific/indigenous-peoples
Hyslop, K. (2017). For Indigenous People, homelessness is more than lacking a home. Retrieved March 15, 2018 from https://thetyee.ca/News/2017/10/30/Indigenous-Homeless-More-Thank-Lacking-Home/
Reading, J. (2009). The crisis of chronic disease among Aboriginal Peoples: A challenge for public health, population health and social policy. Retrieved March 16, 2018 from http://cahr.uvic.ca/nearbc/documents/2009/CAHR-B2-Chronic-Disease.pdf