Summary
Public health related issues dominate the news cycle today, as evidenced by the volume of stories about the COVID-19 pandemic and rise in overdose deaths. We have argued that both of these public health issues are intricately related to a lack of affordable housing in Canada and the subsequent management of homelessness through emergency services like shelters.
At the start of the chapter, we introduced you to the composite characters Stephan and Zane, who were living in a shelter during the COVID-19 outbreak because they were having difficult obtaining employment and housing. The scenario was presented as an entry point into thinking about the complexity of homelessness and public health. We returned to these individual’s story again at the end to demonstrate how it can help us understand the foundational concepts of being trauma-informed, person-centred, socially inclusive, and situated within the social determinants of health as critical for understanding homelessness in Canada.
We then asked you to consider three questions along the way, with the guidance of leading homelessness researchers.
First we asked, “Why are people who experience homelessness at higher risk during a pandemic?” Here we considered the incongruity between public health messages, like asking people to stay at home, and the lived reality of homelessness. We considered research conducted during the H1N1 outbreak and saw that even with this knowledge many homelessness sectors were not able to adequately prepare because they were already dealing with the crisis of homelessness. The design of service agencies, like shelters, serves to increase the spread of disease and we saw this in the high rates of COVID-19 infection, hospitalizations, ICU admissions, and deaths among people experiencing homelessness. Many service providers continued to work through the pandemic, despite their own decreasing mental wellness, because clients needed their support, particularly in rural areas and in relation to domestic violence.
Next we asked, “How is drug use a public health issue?” As a nation Canada has undergone many shifts in drug policy and legislation, but currently harm reduction is a recognized pillar in our strategic approach. In this section we considered the relationship between drug policy and housing precarity, such as the unlawful evictions of people who use drugs because of discriminatory practices. People who use drugs are often isolated and may risk overdosing while alone or with others who are also using drugs at the time. In response, Canada has passed legislation that allows for people to call 9-1-1 and not be charged with being under the influence or having drugs in their possession. There have been calls to decriminalize drugs as a means of further protecting people from the harms they can pose, both medically and socially.
Finally we asked, “Why is harm reduction a necessary approach?” In this final section we made the argument that harm reduction is critical because it is an approach that treats people with compassion while also saving lives. There are many different harm reduction strategies that vary according to individual choice and need. People may substitute one substance for another, use pharmacological treatments like methadone, or engage with managed alcohol programs. These strategies are part of a larger call for safe supply, which was announced in British Columbia amidst critiques that it does not go far enough. In 2003 InSite, the first supervised injection facility, opened in Vancouver and in the time since we have seen the federal roll out of Supervised Consumption Sites and Services that include measures like drug checking. While these are positive steps towards normalizing harm reduction, there is still much work to do in communities across Canada.
