Research Matters Blog

Ontario Non-Profit Housing Association
July 28, 2013

Yesterday, the United Nations marked World Hepatitis Day, a day to “prevent and defeat hepatitis”, a virus infection that affects 1 in 3 people around the world. This number is much smaller for most people in Canada. However, it continues to be quite prevalent amongst those experiencing homelessness. Hepatitis refers to 5 viruses (labeled A through E). The studies in this post focused on Hepatitis B and C, both of which are contracted through bodily fluids. Hepatitis B virus is 50-100 times more infectious than HIV. Hepatitis B can be lethal, but it can also be prevented with a 3 dose vaccination. Hepatitis C can lead to long-term kidney failure and kidney cancer. Hepatitis C is treatable, and in many cases curable, with antibiotics.

The risk of contracting either of these infections can be made even greater with use of injection drugs and participation in higher risk sex (in exchange for money). Both of these activities can be coping mechanisms for those who are most marginalized and experiencing homelessness. The researchers I have worked with to complete these summaries have focused on hepatitis as it relates to: prevalence, prevention, palliative care and education.

Dr. Judith A. Stein completed research on homelessness and the prevalence of hepatitis infections. Her work was predominantly done in the “skid row” neighborhood of Los Angeles. Those who are homeless with hepatitis are less likely to know that they are infected. Those who had consistent case management and medical support were more likely to be aware of their infection. A second study by the same author focused on vaccination for Hepatitis B. The requirement of 3 doses to immunize for hepatitis B is often seen as a barrier to treatment. Those who experience homelessness may find it difficult to return to places to receive 2nd and 3rd doses. The research found that case management was the most important to help people complete the process.

Homelesss people in toronto are 29 times more likely to have hepatitis C
Media Folder: 
 Those who are experiencing homelessness in Toronto are 29 times more likely to have the hepatitis virus. Hepatitis in Toronto leads to additional problems when people who are experiencing homelessness are nearing end of life. Dr. Yonah Krakowsky found that those experiencing homelessness in Toronto are not receiving adequate end of life care. Staff who regularly run programs for those experiencing homelessness require additional training on discussions on topics related to death and dying.

Another study of palliative care also addresses risk associated with hepatitis. Dr. Stacey A. Page noticed a connection between the prevalence of hepatitis, HIV and cancer to a lack of access to healthcare. Barriers to continued treatment prevent people from accessing the care that they need. The research looked at records of those who were homeless when they died. The majority of those who died would have been more comfortable had they had access to treatment at their end of their life.

Education programs are important in order to prevent Hepatitis infection, and to inform people about possible treatments. Dr. Adeline Nyamathi completed a study of two different Hepatitis and HIV education programs for youth experiencing homelessness. One of the programs focused on a nurse-led model, while the other focused on an art intervention model. It is important evaluate the effectiveness of interventions. This research provides a strong argument for the need to test our assumptions, and to understand the importance of good field staff in running successful programs.

Isaac Coplan is a Masters student in Environmental Studies at York University. Isaac is working with Research Impact and the Homelesshub on Knowledge Mobilization. Isaac’s main research interests are in youth homelessness and social exclusion in Canada.

University of Toronto
July 25, 2013

I am proud to be a contributor to the first of a series of annual reports on household food insecurity in Canada. The report is an initiative of PROOF, a Canadian Institutes of Health Research (CIHR) funded research program launched in 2011 to identify effective policy interventions to address household food insecurity.

1.6 million Canadian households experienced food insecurity in 2011

I have two main sources of frustration as someone who has been involved in food insecurity research in Canada for the past 15 years. First, I am appalled by the lack of government attention directed at household food insecurity. In Canada, we have social policies that are meant to mitigate poverty, but we have no policies that target food insecurity, a clear indicator of brutal material deprivation, and one that is closely linked to poor health. Second, I have always been troubled by the media’s and others’ continued reliance on food bank use statistics to define the problem of food insecurity or hunger in our country. Although understandable since other numbers have not been readily available, these statistics diminish the magnitude of this very serious social and public health problem by counting only those who use food banks.

While food bank users represent a very vulnerable group of food insecure, they account for roughly one-quarter of food insecure Canadians. Consider the difference between the 851,014 people who used food banks reported in the Food Banks Canada 2011 Hunger Count and the 3.9 million people living in food insecure households that same year captured in the nationally representative, Canadian Community Health Survey. This shows that many more people than those who seek food assistance are struggling to get enough food.

PROOF’s report on household food insecurity, 2011 marks the beginning of an initiative to make regular, timely summaries of national population statistics on food insecurity more publicly available. The report reveals that almost 3.9 million Canadians experienced some level of food insecurity in 2011, including 1.1 million children! The problem is not under control, with over 450,000 more people experiencing food insecurity in 2011 than in 2008. The report provides detailed information about the extent of food insecurity, what the problem looks like in each province and territory, trends over time, and who is most affected. This information directs us to where urgent policy development is needed. For example, two-thirds of people who rely on social assistance in Canada are food insecure which tells us something out the inadequacy of this policy vis a vis food insecurity. At the same time, the largest numbers of food insecure are found among households who report wages, salaries or self-employment as their main source of income, suggesting that employment in and of itself is not protective.

Household food insecurity by province & territory

We hope that the release of this report will draw attention to the true magnitude of the number of people that face insecure access to food and raise critical awareness of the necessity for this problem to be recognized in policy making. The seriousness of the situation, its impact on individuals, families, communities, on our health care system and economy overall, cannot be overstated, and effective responses are urgently needed from all levels of government.


Naomi Dachner is a Study Coordinator in the Department of Nutritional Sciences at the University of Toronto. Since her MSc – an ethnographic study of food access among homeless “squeegee kids” in Toronto – Naomi has continued research in the area of food insecurity where she has coordinated a variety of community-based research projects, often taking a leadership role in the qualitative dimensions these projects, including: an examination of nutritional vulnerability among homeless youth, studies of charitable responses to hunger in Canada, and an examination of meal services in Salvation Army shelters. Currently, Naomi coordinates PROOF, a 5-year program of research to identify policy options to reduce household food insecurity.

Canadian Observatory on Homelessness/Homeless Hub; York University
July 23, 2013

The National Alliance to End Homelessness conference is happening this week in Washington and I’ve been following the hashtag #NAEH13 to see what’s new in research and homelessness. Iain de Jong (@OrgCode) posted the following: “New Orleans on track to end chronic homelessness by 2015. Huge high five! #NAEH13”

My first reaction, and my reply tweet to him, was “@OrgCode hmm. I'd be interested to see the research. lose 25% plus of your most at-risk pop'n & have hundreds of bldgs for squatters...”

But I decided to do a bit of research – I am after all a PhD student working at a pan-Canadian research network – before being too hasty. Turns out, there may be some truth to it – at least in terms of how it looks on paper. New Orleans, Louisiana (NOLA) has made some great strides in ending, or at least reducing, homelessness.

In a post on OneCPDResourceExchange last week entitled “SNAPS Weekly Focus Guest Blog: Working Together to End Homelessness”, Martha Kegel, Executive Director, UNITY of Greater New Orleans and Stacy Horn Koch, Director of Homeless Policy, City of New Orleans discuss the successes of the plan to end homelessness in New Orleans.

The stats about decreases in homelessness certainly present a clear picture of a dramatic increase (after Hurricane Katrina) and a dramatic decrease. Prior to Hurricane Katrina, there were 2,051 homeless people in New Orleans; two years later that number had jumped to 11,619 people. This number has been steadily declining; in 2009 it dropped to 8,725 and then to 4,903 in 2012. Currently, the number stands at 2,337 – a 47% decrease from last year.

Homelessness in New Orleans 2005-Present

As the chart makes it very clear; homelessness is on the decrease and in a big way, in New Orleans. Kegel and Horn Koch state that the key problem was linked to the impacts of Hurricane Katrina “Just a few years ago, New Orleans had one of the nation’s highest rates of chronic homelessness. This distressing phenomenon was largely due to the lingering effects of the Hurricane Katrina levee failures in 2005, which wiped out the city’s stock of affordable housing, shattered the health and behavioral health systems and scattered the extended family and community networks on which so many vulnerable people once relied.”

Supportive Services

The success in reducing homelessness lies with the City of New Orleans, UNITY of Greater New Orleans and the 63 agencies who are part of the Continuum of Care. This partnership model is very much in line with what we are constantly promoting here at the Homeless Hub, the need for a “systems response” to ending homelessness. The network of agencies work together to help find solutions –systemic and individual—to homelessness in New Orleans.

This model has led to some incredible successes. Not only has total homelessness been reduced but there has also been a focus on chronic homelessness. This has decreased 85% since 2009 – from 4,579 to 633. Kegel and Horn Koch highlight this and say, “What was unimaginable only a few years ago is now within sight: New Orleans is on track to become one of the first cities to eliminate the long-term homelessness of people with disabilities, in line with the federal plan to end chronic homelessness by 2015.”

This has been noted elsewhere as well. In 2011, Community Solutions (formerly Common Ground) reported that “Despite overwhelming obstacles, New Orleans, a partner in the 100,000 Homes Campaign, now boasts the country’s highest housing placement rate for homeless adults.” This is a clear part of New Orleans’ 10 year plan to end homelessness.

In addition to using the systems approach, NOLA is also being very strategic. They recognize that with thousands of abandoned buildings it’s easy for people to stay hidden if they choose. Outreach teams for UNITY concentrate on abandoned buildings as a way of tracking where people might be living. As this article from nola.com explains the city also captured unspent grants for recovery given to developers and is using them to build housing for homeless people and to provide rent subsidies. It also explains another strategy where “The New Orleans Redevelopment Authority is making 20 of its properties available for the program, offering each to developers for 10 percent of the appraised value or $1,345, whichever is higher.” This helps ensure that unused housing is being fixed up and that people who otherwise might remain homeless are getting housed.

The resources for people who are homeless, marginally housed, living in poverty or otherwise vulnerable in New Orleans is quite extensive. A great directory has been compiled by UNITY and can be found here.

But a few counter points:

  • A study of geographic origin of homeless people in Houston found that nearly 2% were from Louisiana. While the study has some methodological challenges, this is nearly double the percentage from California, the next highest state of origin.
  • An article in The Stranger from Seattle, points out that New Orleans’ rate of homelessness as a percentage of the population remains high compared to elsewhere.
  • The extended family living situation common in New Orleans means that there could be a large number of “hidden homeless” people: those who are doubling up with family and friends.
  • The New York Times Katrina diaspora map reminds us that people were flung far and wide post hurricane. Many of those who faced challenges returning were those with low incomes and other marginalization issues.
  • There were many challenges for people who owned their homes in proving home ownership and right to title because of a casual inheritance system common in New Orleans. While that legislation was modified in 2009, prior to that it resulted in many people being homeless or facing challenges in being re-housed. Post 2009, many people who were homeless because of this policy were able to return home.
  • There are still about 35,000 blighted properties in New Orleans. Even the best outreach teams can’t check every home, every night to make sure no one is sleeping there.

None of this discounts the successes that New Orleans has had. The progress it has made is nothing short of remarkable. But the broad, systemic problem of homelessness persists and it is going to need concentrated effort from many sectors to end it.

This article also appears in Tanya's Toronto2NOLA's blog. You can follow Tanya on twitter @TanyaMGulliver.

Working at the Homeless Hub means becoming privy to a seemingly never-ending stream of data and research from experts in homelessness. Our staff are constantly working to update our resources, translate research papers into two-page research summaries and to highlight some of this information in social media through our Twitter feed and Facebook account.

Here are some highlights (good and bad) from the past week:

The Bringing Lethbridge Home Progress Report 2013 was released with some impressive findings to report. “The data collected from the 2012 Homeless Census indicated a 27% decrease in the total homeless population over the past year, the sheltered homeless population decreased by 25% in the last year while those living in absolute homeless decreased by 50%. A total of 99 people were identified as homeless in 2012 census, which is a 27 % decrease from 2011 (136). Since the Homeless Census was conducted in 2008, there has been a 93% decrease in absolute (street) homeless in Lethbridge to 2012.”

Right now we live paycheque to paycheque. I know waht it is like to have $10 left in the bank with pay day a week away... and the rent is due and nothing to pack in my son's lunch...It is a scary feeling.Nelson Daily reports that unfortunately, statistics for Nelson, BC aren’t as positive as Lethbridge. The Nelson Cares Society released its 5th Annual Report Card on Homelessness and reported that: the number of emergency stays only decreased 4% between 2011 and 2012 (from 414 to 396) but the average stay increase by 3 days (from 9 days in 2011 to 12 days in 2012) for a 26% increase. Nutritional vulnerability and poverty meant that meals served at Our Daily Bread increased by 5% from 11,700 in 2011 to 12, 268 in 2012.

Waterloo’s STEP Home (Support to End Persistent Homelessness) Program reports that, “For every dollar spent in the housing stability sector, $9.45 comes back to the community in social return.” They also share that managing and ending homelessness have two different price points: “Further, local research demonstrates that managing homelessness by providing emergency services is 10 times more expensive than ending homelessness by providing adequate housing and support.”

In an op-ed in the Winnipeg Free Press, Jino Distasio, the director of the Institute of Urban Studies and co-principal investigator for the Winnipeg site of the At Home/Chez Soi Project writes about the rooming house paradox. His article examines the horrible conditions of many of Canada’s rooming houses and the co-existing need for safe, affordable housing. He says, “Herein lies a paradox. While we know it is critical to have all Canadians live in safe, affordable housing, closing hundreds, if not thousands of rooms would put a massive burden on an already strained system.”

Our latest research summary examines education access for young women experiencing homelessness. The goal of the research by Jaskiran Dhillon was to document how young women who are homeless or living on the street describe their experiences within education. Read the full research summary here.

Canadian Observatory on Homelessness/Homeless Hub; York University
July 16, 2013

It’s hot out there! Most of Canada is expected to experience a heat wave, or near heat wave conditions for much of this week. Already this year we’ve seen deaths of children in Ontario and Alberta after they were forgotten in a vehicle for a short time. According to San Francisco State University, 20 children in the US have died in cars already this year; 33 died last year.

Typically, concerns for homeless people and other vulnerable populations rise when temperatures are cold, but heat is actually the number one weather-related killer in North America. In fact, heat kills more people annually than all other weather conditions combined including tornados, floods, hurricanes, tsunamis and earthquakes. In Toronto, for example, it is estimated that 105 people die from cold each year and 120 from the heat. Numbers are similar in other North American cities.

Man under the sun

It is critical that municipal planning for emergencies includes addressing how homeless people will be protected during heat waves and other extreme weather events.

Toronto has one of the best developed hot weather response plans in North America. It includes a partnership roundtable involving community and city services who mobilize different levels of activity during heat or extreme heat alerts. The city calls a heat alert “when forecast weather conditions suggest that the likelihood of a high level of mortality is between 25 and 50 percent greater than what would be expected on a typical day” and an extreme heat alert when the mortality is 50% or greater.

For my Master in Environmental Studies at York I worked with the Parkdale Activity-Recreation Centre, Sistering Drop-In and the City of Toronto to develop a risk-based heat registry to protect low-income, homeless and marginally housed individuals during extreme hot weather. The city has created a Heat Registry Manual that is available for community agencies to modify and adopt to create their own registries. Examining several different factors we determined what would make someone at increased risk during heat waves including physical and mental health, housing situation (or lack thereof), social isolation and addictions.

Highest risk of heat stroke

This is echoed by Health Canada who says that the joint factors of chronic illness, certain medications and living alone can combine to make someone extremely vulnerable. Homeless people, who are often socially isolated, would also fall into this category.

In, Beating the Heat on the Street, from Partners for Assistance in Transition from Homelessness (PATH), Steven Samra shares some tips for outreach workers assisting homeless populations including carrying extra water, providing transit tickets and allowing people access to air conditioning.

 

 

Some other heat-related resources:

Health Canada - Communicating the Health Risks of Extreme Heat Events: Toolkit for Public Health and Emergency Management Officials

Health Canada – Community Care During Extreme Heat – Heat Illness: Prevention and Preliminary Care

The City of Toronto’s Beat the Heat pamphlet is available in 20 different languages including Russian, Urdu, Spanish and Tamil.

Centers for Disease Control and Prevention – Prevention Guide to Promote Personal Health and Safety: Extreme Heat

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.