Housing

P R E S E N T E R T O O L – R E V I S E D S U M M E R 2 0 1 3

HOUSING

http://www.arsior.com/wp-content/uploads/2011/03/Healthy-home.jpg

HOUSING – OUTLINE (PREZI)

• 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-724-29113http://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.issue-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

http://skuliavas.files.wordpress.com/2011/12/img_0151.jpg

Attawapiskat Housing

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?

http://www.openfile.ca/vancouver/blog/curator-blog/photo/2012/early-1970s-squatters-camp-coal-harbour

VANCOUVER 1972

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.