Chronic Homelessness in Toronto as a Public Health Issue
Photo by Jonathan Kho on Unsplash
Photo par Jonathan Kho sur Unsplash
Landon Apollo Leone
(FR) Cet article postule que le sans-abrisme continuel à Toronto est un problème de santé publique, et que celui-ci persiste du fait d’un décalage entre la santé publique et l’urbanisme. De plus, les refuges pour sans-abri comme le projet Out of the Cold, par exemple, doivent continuer à faire partie des mesures mises en place par Toronto. Cet essai soutient également que la plupart des initiatives de lutte contre le sans-abrisme à Toronto aujourd’hui ne sont que des solutions à court terme, et que les programmes de résilience urbaine à long terme doivent s’attaquer aux inégalités de revenus urbains à la racine, par le biais de programmes de distribution des richesses ou par un revenu universel de base. La crise sanitaire actuelle de Covid-19 force ces refuges pour sans-abri à fermer temporairement ou du moins à limiter le nombre de personnes admises chaque nuit, ce qui laisse plusieurs dans le besoin à la rue. Enfin, dans cet essai, il est expliqué en quoi le sans-abrisme est considéré comme une crise de santé publique, ainsi que les facteurs qui contribuent à la récurrence de ce problème, les prescriptions politiques préexistantes et recommandées et enfin les initiatives de base qui cherche à lutter contre ce problème urbain.
Urban chronic homelessness is a public health issue that has remained as such due to the disconnect between public health and urban planning. Homeless shelters and other anti-homelessness initiatives must remain and be expanded upon as a part of cities’ resiliency plans until the issue of chronic homelessness is eradicated from the urban environment. Most of today’s anti-homelessness initiatives in Toronto are merely short-term solutions and long-term urban resiliency programs are needed to tackle urban income inequalities at their roots, through wealth distribution programs or a universal basic income plan. This essay highlights the importance of chronic homelessness as a public health issue. It cites some of the main contributing factors to chronic homelessness in the City of Toronto and other global cities. Furthermore, existing initiatives that address and mitigate chronic homelessness are discussed, as well as their limits. Finally, recommendations are made to further combat chronic homelessness in Toronto specifically.
The Importance of Chronic Homelessness as a Public Health Issue
According to the American Public Health Association (2017), homelessness is a public health issue, as “those experiencing homelessness have high rates of chronic mental and physical health conditions, co-occurring disorders, and barriers to care, such as inability to access care when needed or comply with prescribed medications.” Chronic homelessness in Canadian cities severely affects the health of individuals within them. Anti-homelessness measures benefit both homeless individuals and other urban inhabitants by removing potentially sick or mentally unhealthy people off of the street where they could be a danger to the public and, more likely, to themselves. Ferreira (2020) explains how mental illness is often more prevalent among homeless individuals. Unfortunately, not only is adequate access to mental health services a challenge for homeless populations across the country, but access to physical health-care services is as well. As a result, homeless people are less likely to access consistent preventative care (Ferreira, 2020).
Another connection between chronic homelessness and public health is evident in the context of the current pandemic. Ferreira (2020) argues that the communal setting that characterizes many homeless shelters places clients at a greater risk of contracting and transmitting COVID-19. Furthermore, the two-meter separation that was enacted as a precautionary measure to quell the spread of the virus made personal, social, and physical contact with others, activities that are pertinent to the mental health of any individual, difficult (Ferreira, 2020). Finally, there is a trade-off between the need for green spaces to bolster the public health of urban residents, and the green gentrification and chronic urban homelessness due to rising rent costs that often follow. Wolch et. al. (2014) contend that the creation of urban spaces which are “just green enough” to both reap the public health benefits of improved access to urban green space while avoiding the “urban green space paradox” of eco-gentrification is needed. Ultimately, the disconnect between public health and urban planning, highlighted by Corburn (2004), must be mitigated; urban planning often provides both the foresight and the infrastructure necessary for the implementation of successful public health initiatives. Of equal importance is understanding public health as not dependent entirely on individual life choices, but as influenced by factors that may be out of an individual’s direct control, an argument further elaborated on by both Hawe (2009) and the following segment of this essay.
The Main Contributing Factors to Chronic Homelessness in Toronto
Dollar (2004) sees the development issue as five billion people who are already prosperous or on track to be so, and one billion who are stuck at the bottom. Toronto’s homeless urban citizens clearly fit into the category of those stuck at the bottom, living in an underdeveloped urban space despite residing in a city with an average income for working age adults of almost $50,000 CAD (StatsCan, 2019). Urban inequalities, whether they be economic, political, social, cultural, environmental, spatial, or knowledge-based, jeopardize the sustainability of economies and communities alike. Gosh (2016) contends that the increase in economic inequality originated in the 1980’s and 1990’s, when the neoliberal paradigm became dominant in Western countries. He goes on to define neoliberalism as the assumption that the benefits of the growth generated by market forces would ultimately “trickle down” to poor and vulnerable populations. However, due to globalization, inequalities are typically distributed unevenly both between and within regions, whether they be urban, peri-urban, or rural (Ghosh, 2016). Inequality affects every urban citizen and reduces the efficiency of efforts to meet other priorities.
Green gentrification further contributes to chronic urban homelessness, especially within the City of Toronto. As Wolch et. al. (2014) explain, while the creation of new green space to address environmental justice and mental health problems within cities can make neighborhoods healthier and more esthetically attractive, it also can increase housing costs and property values. This can lead to eco-gentrification and a displacement of the very residents which the green space strategies were designed to benefit, continuing chronic homelessness within the city. To combat this issue, Wolch et. al. (2014) propose that urban planners, designers, and ecologists focus on urban green space strategies that are “just green enough” and which explicitly protect social as well as ecological sustainability. They maintain that these bottom-up urban green space strategies can be supported by anti-gentrification policies, including provision of affordable housing and housing trust funds. Furthermore, rent stabilization programs can reduce absentee landlordism, while financial incentives for homeownership and shared equity housing projects can allow existing residents to have a stake in an improving neighborhood (Wolch et. al. 2014).
Incompatibility and a lack of cooperation between differing levels of government, coupled with provincial hegemony over municipal legislation, gives Toronto’s public health officials an excuse for failure regarding Toronto’s homeless population. This is unacceptable and ultimately dangerous as Covid-19, for example, has made evident how severely disease spread can affect the homeless community. Already, 14 of the 75 shelters in Toronto have reported outbreaks of the virus, with two Covid-related deaths confirmed as being members of the city’s homeless community (Adelitala, 2020). Moreover, the infection rate of Covid-19 in shelters is around 35 times higher than in the general population of Toronto (Ferreira, 2020). Individuals who have no form of permanent shelter for most or all of the year cannot effectively quarantine, an obvious issue during a pandemic wherein household quarantine promotion seems to be the most effective public health response in preventing viral spread. In addition, many homeless individuals in the Toronto have a number of pre-existing health conditions, including lung diseases, heart diseases, and diabetes, making them more likely to develop severe cases of Covid-19. However, Ferreira (2020) elaborates that Toronto’s homeless population is often afraid of the treatment that they will receive once they enter a medical institution, lacking confidence that they will be treated with dignity and respect by medical staff.
Existing Initiatives Addressing Chronic Homelessness and Their Limits
The Out of the Cold Project, based in the City of Toronto and operating throughout the Greater Toronto Area, is comprised of a series of homeless shelters that seek to bolster public health by combatting the chronic homelessness that has plagued Toronto for decades. The Out of the Cold Project was founded in 1988 as an “umbrella organization to provide financial support for Out of the Cold projects” in many cities across Canada (Out of the Cold, n.d.). A volunteer-based organization, Out of the Cold partner locations provide “basic physical needs of shelter, food, and warm clothing for the less fortunate members of our society – as well as responding to the deeply human needs of compassion, dignity and self-worth” (Out of the Cold, n.d.). The Out of the Cold initiative – similar to others across the Greater Toronto area – is designed to benefit members of an urban society who are homeless by providing them with food, safety, and shelter during the night, which is especially crucial during the freezing winter and sweltering summer months. The Out of the Cold Project and other anti-homelessness initiatives have tried to bolster public health, sustainable development, and urban resiliency despite inconsistent government funding from both municipal and provincial government agencies.
These anti-homelessness initiatives are often citizen-led grassroots movements that receive government and private-sector funding. Unfortunately, the limits of homeless shelters in particular have been made clear during the current Covid-19 pandemic. Many shelters are closed, forcing homeless residents back onto the streets during a time when self-isolation is of utmost importance. Others, such as Sanctuary Ministries Toronto, have allowed their homeless clients to continue to eat their meals inside the facility, take showers, or use the restroom, but with an allotted time slot of only 30 minutes (Ferreira, 2020). Ferreira (2020) explains further that only 10 clients are allowed inside at a time, in buildings with a capacity of nearly 200. Additionally, she describes the impact of the pandemic as most severely felt in the shelter’s outreach efforts, particularly in its housing resettlement program, which provides support to former homeless people that have secured low-income housing.
Ferreira (2020) also outlines how effective public pressure and grassroots mobilization can be. Criticism of government and public health authorities for their slow response in supporting Canada’s urban homeless during Covid-19 has resulted in the federal government announcing a total of $157.5 million for assisting the general homeless population with physical distancing. The City of Toronto has also launched a program focused on moving people out of congregate living situations, such as shelters, and into hotel rooms and apartments that have been bought or leased for the duration of the pandemic (Ferreira, 2020). To effectively mitigate chronic homelessness, however, these government support programs must continue once the pandemic has abated.
Recommendations to Further Combat Chronic Homelessness in Toronto
Homeless shelters are a temporary solution. Chronic homelessness must be addressed at its roots: severe income and wealth inequalities, an increase in precarious and temporary employment, and ever-increasing rent prices, all of which are prevalent in urban environments. Keil and Ali (2007) argue that inequalities must be tackled at the urban governance level, through the pursuit of collective goals in an inclusive strategy of resource mobilization. They maintain that, through “metropolitanization,” public policy creation increasingly occurs at the municipal governance level. This trend must be allowed to continue to bridge the disconnect between public health and urban planning facilitated by different levels of governance dealing with different issue-areas without enough collaboration. Yet, provincial scale is still extremely important in the Canadian political system, where municipalities are dependent on upper-level policy frameworks and financing without much autonomy for local agencies and institutions (Keil & Ali, 2007). This leaves urban governance, even in a global city like Toronto, severely restricted in its response to distinctly urban problems such as chronic homelessness.
For the time being, a large aspect of the City of Toronto’s resiliency plan must be the Out of the Cold Program and other anti-homelessness initiatives like it. The Toronto low-income housing shortage has reached a level of crisis, meaning the city must prioritize more overnight shelters for the ever-increasing homeless population. However, any long-term urban resiliency program must tackle urban income inequalities at their roots, through wealth distribution programs or a universal basic income plan. Other inequalities which the current homeless population face must not be forgotten either. As Ghosh (2016) derives, quelling first-world inequality requires an effective and sustainable route out of poverty for the working-age population. Such a route may include, but is not limited to, an influx of higher-paying and less precarious urban jobs, effective labour market institutions, equitable access to quality education, and lower-level government and policy-making that is both high functioning and publicly accessible to ensure accountability to all income-level citizens.
In conclusion, the ultimate solution to chronic homelessness seems deceptively simple: provide affordable housing. The best protection from public health issues such as urban pandemics like COVID-19, for all urban residents, is ensuring universal access to permanent residency. Nevertheless, up to 235,000 Canadians still circle through homeless shelters each year (Ferreira, 2020). Relentlessly, the wealthy mobilize their political and financial influence over urban municipal policy and effectively militarize the city in response to whatever causes they see fit (Zuberi, 2010). Academics must work tirelessly to afford this power to all members of the urban community. As David Harvey (2000) explains, we the people currently have little right to choose the kind of city we inhabit, despite the fact that as we produce our cities, we produce ourselves. Therefore, if we want to mitigate inequality and reconnect urban planning and public health to combat both chronic homelessness and the spread of disease, cities are the place to start.