New book examines homelessness issues in Canada

Ryan McNeil, a Simon Fraser University postdoctoral researcher, hopes health care providers and policy makers dig deep into a new book he has co-authored to improve health care for Canada's approximately 200,000 homeless people.

Homelessness & Health in Canada, published by the University of Ottawa Press, is the first book in Canada to explore how social, structural and environmental factors shape the of the nation's homeless populations. As an open source publication, the entire book can be accessed online for free.

"We understand that financial and other barriers often prevent academic research from reaching lay communities," says McNeil, a health scientist.

Affiliated with the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS, McNeil adds: "We see the free and easy accessibility of this book as one of its greatest strengths. While it mainly targets researchers, policymakers, health and social services professionals and students, we hope that the book reaches a general audience with an interest in homelessness."

McNeil, Manal Guirguis-Younger and Stephen Hwang coalesce new research findings with substantive reviews of existing research by emerging and established health researchers to create a blueprint for improving homeless people's health from youth to end-of-life.

Covering a wide range of topics, including the varied makeup of homeless populations, the authors outline policy and practice recommendations to address this ongoing public health crisis.

Approximately 200,000 people experience homelessness in Canada yearly. Their living conditions are much more varied and overlapping than what we see in driving through high profile homeless areas such as a region of Hastings Street in Vancouver's Downtown Eastside.

"While homelessness encompasses a range of living situations from sleeping outside and staying in emergency shelters to couch-surfing, homeless populations are linked by poor overall health," notes McNeil. "In our book we argue homelessness is one of Canada's most urgent health crises and, while increased investment in social housing is desperately needed, there is also a need for targeted health programs."

Half of the book contains new research originating in Canada. Divided into three thematic sections, the book explores:

  • How homelessness affects the health of particular homeless populations, such as youth, immigrants, refugees and people of Aboriginal ancestry.How new evidence-based approaches to improving population health outcomes and health-care services delivery could be used to inform the creation of more effective homelessness policies and programs. For example, community- and shelter-based health services are shown to optimize access to care.
  • How emerging best practices in the care of homeless populations could improve their health. This section includes chapters exploring: the integration of mental health services within a shelter-based, managed alcohol program, innovations in integrating homeless health-care services and the development of an emergency shelter-based hospice.

The following are examples of new research featured in the book Homelessness & Health in Canada:

  • Chapter 3 reports findings from the Coming Together project in Toronto, Ontario, which explored how Aboriginal women and transgender women negotiate and survive the many challenges of homelessness and unstable housing. The chapter highlights the severe marginalization that these populations encounter in Canadian society. Its recommendations aim to help policymakers and service providers empower these women.
  • Chapter 4 reports findings from a community survey that explored the impact of residential crowding on Inuit people in Nunavut. The shortage of safe affordable housing is linked to high levels of residential crowding and self-reported health problems.
  • Chapter 5 explores how homelessness impacts self-reported health status and health care access among immigrants and refugees. Findings are based on data from the Ottawa Panel Study on Homelessness, a longitudinal study that examined changes in housing status and health among a cohort of in the greater-Ottawa region. The study found that immigrants and refugees experienced better physical and mental health than their Canadian-born counterparts, though still demonstrated a high need for health services.
  • Chapter 9 explores how nurse-patient interactions shape health care access among homeless and street-involved populations. Drawing on ethnographic fieldwork in health care settings, the researchers show how, by adopting non-judgmental, harm reduction approaches, nurses are better able to facilitate access to services.
  • Chapter 10 examines factors that influence the location and design of community and shelter-based health facilities for homeless populations. These facilities are increasingly playing a prominent role in health services delivery to populations. This chapter outlines important recommendations to inform the continued development of these services nationally and internationally.

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