HOUSING
PRESENTER TOOL – REVISED SUMMER 2013
http://www.arsior.com/wp-content/uploads/2011/03/Healthy-home.jpg
HOUSING – OUTLINE (PREZI)
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Objectives
TED Talk
Housing and Health
Housing as a social determinant of health
Housing and the global context (MDG)
Housing and the local context
Housing and Primary Care
Discussion / Activity
OBJECTIVES
• To be able to describe 3 ways in which housing
affects health
• Be able to name the MDG that corresponds to
housing
• Be able to describe to colleagues why an
understanding of a patient’s housing is crucial in
primary care
BECKY BLANTON: THE YEAR I WAS
HOMELESS
• Becky Blanton planned to live in her van for a year
and see the country, but when depression set in
and her freelance job ended, her camping trip
turned into homelessness. In this intimate talk, she
describes her experience of becoming one of
America's working homeless.
• Becky Blanton is a writer, photographer and former
journalist who found herself homeless, but bounced
back to tell her story and inspire others
BECKY BLANTON: THE YEAR I WAS
HOMELESS
During this TED talk, pay special attention to:
• What basic needs become more difficult when you
are homeless
• The effects of inadequate housing on health
TED TALK
• http://www.ted.com/talks/becky_blanton_the_year
_i_was_homeless.html
AFTER WATCHING THE TED TALK….
• What basic needs become more difficult to address
when you are homeless
• The effects of inadequate housing on health
HOUSING
• Why is housing important?
IMPORTANCE OF HOUSING
• Housing is important on many levels
• Housing fulfills physical needs by providing security
and shelter from weather and climate
• It fulfills psychological needs by providing a sense of
personal space and privacy.
• It fulfills social needs by providing a gathering area
and communal space for the human family, the
basic unit of society
• In many societies, it also fulfills economic needs by
functioning as a center for commercial production.
http://www.hrea.org/index.php?doc_id=411
http://severe-wx.pbworks.com/w/page/15957980/Blizzards%20and%20Cold%20Waves
http://www.colourbox.com/image/concept-photo-crime-robbery-theft-or-blackmail-in-the-street-image-2792945
http://organizesimplifyconnect.com/wp-content/uploads/family-in-the-kitchen-cooking-lg.jpg
http://en.wikipedia.org/wiki/File:Fireplace_Burning.jpg
http://www.hopnews.com/page3_138.html
http://www.cindysbedbreakfast.com/
HOUSING
• What basic needs are compromised when you’re
homeless?
(bathe, hold down a job, use your skills, feed yourself,
stay warm/dry/cool, host friends, socialize, interact
with people in a safe space, feel safe)
HOUSING
• How did not having housing impact upon Becky’s
life and health?
(bathing, weather, police, mental health, trying to be
invisible, feeling as if no one cares –suicidality,
showering, food production, taking care of pets)
IMPACT OF HOUSING
• What attitudes did Becky encounter as a result of
being homeless?
(negative perceptions from society, police, other
homeless people)
HOUSING AND HEALTH
• Can you think of some examples (present day or
historical) of how inadequate housing has an
impact upon health?
Cholera, TB, Diarrheal Diseases, Pertussis
http://recipehealth.net/wp-content/uploads/2012/07/cholera.jpg
http://newspaper.li/tuberculosis/
http://www.topnews.in/health/diseases/tuberculosis
http://www.ourbabynews.com/risk-of-diarrheal-disease.html
http://en.wikipedia.org/wiki/Pertussis
THE IMPORTANCE OF HOUSING – AN
OLD IDEA (EXTRA)
• The following relates to an outbreak in New York over one
hundred years ago:
• The real suffering of the poor is easily explained. They lived in
the worst houses in the most crowded portions of the city and
could not afford to flee when threatened by the epidemic. In
New York, for example, it was not until death and public
removal had thinned their ranks that the epidemic began to
subside. Basement apartments were from six to four feet
below the surface of the ground, and from these warrens
came the “greater proportions and worst forms of cases.”
NYC Board of Health, Reports of Hospital Physicians, 1832
IMPORTANCE OF HOUSING
• Historically cholera has been one of the most
socially graded diseases and intimately related to
housing
http://www.topnews.in/health/haiti-cholera-toll-goes-724-29113
http://blogs.discovermagazine.com/discoblog/2007/06/27/victorian-doctors-not-as-dumb-as-you-think/
THE MANY EFFECTS OF HOUSING ON
HEALTH
http://journals2.scholarsportal.info.myaccess.library.utoronto.ca/show_image.xqy?path=annualreviews_backfiles_PUBLHEALTH/publhealth.2004.25.issu
e-1/annurev.publhealth.25.101802.123036/graphic/pu250397.f1.eps
HOUSING AND HEALTH (PREZI)
• Homeless people are also at greater risk of
premature death compared to the general
population
• In the United States, being homeless can shorten life
expectancy by 20 years (Wright et al., 1998)
• City of Toronto data show that young homeless
men in Toronto are eight times more likely to die
prematurely than men of the same age in the
general population (Kushner, 1998)
http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php
SOCIAL DETERMINANTS OF
HEALTH
GLOBAL CONTEXT
MILLENNIUM DEVELOPMENT GOALS:
WHERE DOES HOUSING FIT IN?
MILLENNIUM DEVELOPMENT GOALS
HOUSING - GLOBAL CONTEXT(MDG)
• GOAL 7:
ENSURE ENVIRONMENTAL SUSTAINABILITY
• Target 7.C:
Halve, by 2015, the proportion of the population
without sustainable access to safe drinking water
and basic sanitation
• Target 7.D:
By 2020, to have achieved a significant
improvement in the lives of at least 100 million slum
dwellers
HOUSING AND THE UNIVERSAL
DECLARATION OF HUMAN RIGHTS
(EXTRA)
The right to housing is codified as a human right in the
Universal Declaration of Human Rights:
"Everyone has the right to a standard of living
adequate for the health and well-being of himself
and of his family, including food, clothing, housing
and medical care and necessary social services,
and the right to security in the event of
unemployment, sickness, disability, widowhood, old
age or other lack of livelihood in circumstances
beyond his control." (article 25(1))
http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php
HOUSING AS A HUMAN RIGHT
“The human right to adequate housing is the right of
every woman, man, youth and child to acquire and
sustain a secure home and community in which to
live in peace and dignity”
http://www.hrea.org/index.php?doc_id=411
http://media.treehugger.com/assets/images/2011/10/20100125-haiti-earthquake-damage.jpg
HOUSING - LOCAL CONTEXT (PREZI)
• In 1986, the Ottawa Charter for Health Promotion
(WHO, 1986) recognized shelter as a basic
prerequisite for health
• It is only recently however, that researchers and
policy-makers have focused on housing as an
important determinant of health
• Housing insecurity can be determined by various
indicators, including the number of people who
sleep in the streets, use temporary shelters, live in
substandard dwellings, and who spend more than
30% of their income on housing.
http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php
HOUSING – LOCAL CONTEXT
• What makes someone “housing insecure”?
• How can we determine that someone does not
have access to adequate housing?
HOUSING- LOCAL CONTEXT
• When rents are unaffordable, it is difficult to cover
other necessities such as food, thereby contributing
directly to food insecurity
• When families spend more than 50% of income on
housing, it significantly reduces amounts that can
be spent on recreation, food, and other social
determinants of health
http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php
HOUSING - LOCAL CONTEXT
• Canada Mortgage and Housing Corporation (CMHC) uses the term 'core
need' to track the number of households unable to access adequate
rental accommodation in their community.
• The term measures affordability, suitability of accommodation and
adequacy. Households with core housing needs face one or more of the
following issues:
- Affordability: They spend more than 30% of their gross income on
housing.
- Suitability: They live in overcrowded conditions, i.e., household size and
composition exceeds their actual home space requirements.
- Adequacy: Their homes lack full bathroom facilities, or require significant
repairs (Layton, 2000).
http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php
Attawapiskat Housing
http://skuliavas.files.wordpress.com/2011/12/img_0151.jpg
HOUSING - LOCAL CONTEXT (EXTRA)
“Do you remember what it was like growing up? Having
a warm, welcoming home that always felt safe? A
backyard to play in? Food in the fridge? At the time, you
likely didn’t think about those things. No one could
blame you for taking them for granted. Carefree; that’s
how growing up should be. But life is not carefree for
children of the 1.5 million Canadian families in need of
safe, decent and affordable shelter. Many Canadian
families live month to month, making it nearly impossible
to get ahead. They’re forced to decide between heat
and rent – a choice no family should ever have to make.
Every Canadian family deserves a safe, decent and
affordable place to call home.”
Habitat for Humanity Canada
HOUSING AND PRIMARY CARE
• Primary health care refers to an approach to health
and a spectrum of services beyond the traditional
health care system
• It includes all services that play a part in health,
such as income, housing, education, and
environment
• Primary care is the element within primary health
care that focuses on health care services, including
health promotion, illness and injury prevention, and
the diagnosis and treatment of illness and injury
HOUSING AND PRIMARY CARE (PREZI)
• Why is it important for family doctors to know about
their patient’s housing situation?
HOUSING AND PRIMARY CARE
• As family doctors we are in the business of preventative
care and trying to create good health outcomes for
patients
• It is therefore crucial for us to have a good
understanding of the determinants of health
• Without understanding the factors influencing our
patients’ health, it is difficult to have an impact upon
their health
• Housing will greatly affect patients’ health and is
therefore important for family doctors to address
HOUSING AND PRIMARY CARE
• Since housing has such a large impact on health, it
is important for primary care practitioners to
consider the housing needs of their patients
• Housing will affect patient’s physical, emotional and
social well-being
DFCM CORE COMPETENCIES (EXTRA)
• Elicit information regarding the social situation of
the patient
• Assess the impact of social conditions on the
presenting symptoms
• Explore the patient’s cultural and social context
including recent travel, lived experience and
environmental factors to understand how these
may influence the presentation of their symptom(s)
• Link patient’s symptom to their social situation and
to a lifestyle behaviour and in doing so, employ the
principles of disease prevention and health
promotion and advocacy
ACTIVITY 1: HOUSING AND PRIMARY
CARE (PREZI)
• Divide into groups of 3. List the various ways that we
can advocate for patients and their housing needs
ACTIVITY 2 – REFLECTIVE WRITING
Imagine you are homeless.
Like Becky you used to have an apartment, a job,
friends, and a family. Over the last year you have
sunk into a depression, you have stopped working,
you no longer see your friends, and you are unable
to pay the rent. It is early September.
Write about your first night sleeping out on the
streets of Toronto, how do you feel, what are your
fears, what possessions do you have with you, how
does the world around you look?
VANCOUVER 1972
http://www.openfile.ca/vancouver/blog/curator-blog/photo/2012/early-1970s-squatters-camp-coal-harbour
ACTIVITY 3: HOUSING
• What comes to mind when you see this picture?
• What basic needs would be difficult to meet if this
was your living reality?
• What are the health consequences this living
situation?
ACTION PLAN
Group Discussion:
• After today’s workshop, make a list of
tangible action plans to implement in your
respective practices.