City View United ChurchOttawa, Ontario

November 1, 2010

The Health Consequences of Poverty in Canada

Overview

• Reflections on poverty & health• It’s all about values

• A community response to a health and social issue

• ICHP

• Advocacy: Poverty as an expression of societal values

Poverty & Health

Poverty is a lack of basic human rights

lack of representation and

freedom

Poverty is Poverty is powerlessnepowerlessne

ssss

Caring for Canada’s Most Vulnerable

• 1st Nations• Rural• Single parent families• Mentally and physically disabled• Psychiatric illness• Addictions• New immigrants• The young and the elderly

Advocating for Health

As health care providers, opportunities to improve health in both developing and developed countries include:

• creating effective health delivery systems for prevention and care,

• anti-poverty measures,

• direct health care service and

• effecting positive social change

Ottawa Inner City Health

An Innovative Model of Collaborative

Health Care for the Homeless In Ottawa

History of the OICHP Initiative

• OICHP grew out of strong concern that health needs of chronically homeless were not addressed adequately despite high rates of health service utilization and associated cost.

Example: in the 7 months prior to admission to the OICHP, this gentleman had 191 trips to The Ottawa Hospital emergency by ambulance. In five months following admission to OIHCP he had 0.

Health Care for Vulnerable Populations

• OICHP partners recognize our collective obligation to provide services to people with severe and persistent mental illness and/or substance abuse who were otherwise barred from receiving services

Complexity of Needs

In addition to complex physical health problems approx 95% have severe and persistent mental illness and 95% have addictions.

The typical OIHCP patient is a 45 year old male who is living with HIV, Hepatitis, severe and persistent mental illness and multiple substance addiction who has been homeless or incarcerated 20+ years.

The Mission Hospice

• Serves men and women

• Shift from AIDs to Cancer care

• Focus on care for people living with concurrent disorders

• Importance of culture and community

Women’s SCU

• Mostly serving IDU/sex trade workers

• Strong partnership with Drug and Mental Health court programs

• Also have health promotion CD treatment etc

Wet Program

• Very low barrier program

• Most clients are aboriginal, quite young and, living with a brain injury (ie FASD, ABI or both)

• Hugely challenging!!

Primary Care Clinic

-5 days per week nurse

Practitioner

-1.5 days per week

HIV clinic

-1 day per week psychiatric

nurse practitioner

-dental clinic

Oaks Program

• Supportive housing for seniors, graduates from Managed Alcohol program

• High intensity of care needs

• Focus on “normal” living skills and experiences

Senior Womens Project

• Scheduled to open in June 2011

• Will house 22 formerly homeless seniors women

• Funded through the Assisted Living Program

Treatment Outcomes

Successful treatment for condition for which patient was admitted which accords with Canadian standard for care

85%

Primary Health Care Needs and Screening for Disease completed

89%

Reduction in Risk Behaviors including substance abuse

64%

Appropriate use of hospital and EMS services 91%

Compliance with Recommended Medical treatment 95%

SERVICE SECTOR % PATIENTS RECEIVING SERVICES

Hospital Care In patient 26%

Out patient 48%

Royal Ottawa Hospital

33%

Community Health Care

CCAC 38%

Community Health Centres

50%

Community Mental Health Services

13%

Housing Supportive Housing Providers

20%

Day Programs 8%

Patients report

-better health,

-improved compliance

with medical care

-less use of emergency

health services

-reduced substance abuse

-sense of community, home and family

Service providers report -more efficient service utilization-improved health outcomes for patients-greater compliance with medical care

-reduced substance abuse

Community partners report Dramatic reductionin public inebriation, panhandling,police contactantisocial behavioursDramatic increase in positive self care behaviours

Pre-Program In Program

ER Admission

Pre-Program In Program

Police Reports

*One subject decreased from 5.1 to 4.8 emergency visits per month

Pre-program and In-program Emergency Room Visits and Police Reports per  Month by Subject n=17

Advocacy: Poverty as an expression of societal

values

Policy Changes Driving Homelessness

• Cuts to welfare (example dismantling CAP in the 1990

• Cuts to social housing

• Restructuring the health care system

• Shift from social to individual rights

• Return to notion of poverty

as a personal responsibility

Combined with• Portrayal of the homeless as not being self

reliant, not contributing members of society, exclusion as members of the community

• Promotion of solutions to homelessness which end dependence on government or community

Why have we as a society not been able to:

• It’s clearly not because of a lack of ability. . Therefore it must be a lack of will

• Is it our inability as advocates to frame our arguments in terms of values which are “Canadian”?

• Is it our inability to change policies of the provincial and federal government which have created homelessness?

What Are Canadian Values?

• Value equality, social safety net, safe and healthy communities but:

• 60% of Canadian endorse the view that “People who don’t get ahead should blame themselves not the system”

• 53% agreed that “people who don’t work turn lazy”

• Evidence of deep rooted prejudice against the poor which is tolerated in ways other kinds of prejudice are not

We have not effectively advocated for our most vulnerable

• poverty as an expression of values• poverty in the context of a human right• anti poverty strategies as cost-effective• civic professionalism• research: evidence informed decision

making

Homelessness as a Human Rights Issue

• People experiencing homelessness face violations of a wide range of human rights

• Changes the debate from a housing debate to a debate about

the rights of citizens who

are ENTITLED to

protection

How Does the Human Rights Argument Advance the

“Cause”?• Important consequences for how society

perceives and treats the homeless• Acknowledges that homelessness is more than

a housing issue• Shifts perception of the homeless as objects of

charity to citizens entitled to protection under international law

• Would require all levels of government to commit to take steps to realize human rights of the homeless

Poverty and Health

Wealth= Health

opportunities for health care providers to improve health include:

• creating effective health delivery systems for prevention and care,

• anti-poverty measures, • direct health care service and • effecting positive social change

“No child left behind”