Everyone in Ontario has a right to adequate shelter.
Article 25.1 of the United Nations’ Universal Declaration of Human Rights (1948) states that:
“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.”
Adequate shelter is a basic prerequisite of health. Without it, there are far reaching implications on other determinants of health. The Registered Nurses Association of Ontario (RNAO) believes that nurses have a professional and moral responsibility to speak out against homelessness to ensure and protect the overall health of Ontarians.
There are different ways in which homelessness occurs. These include:
The 1993 cancellation of Canada’s national housing program, the 22% reduction of welfare rates in Ontario, the 1998 cancellation of the Ontario Rental Housing Protection Act and the continuing loss of private rental (between 1996 to 2001: 44,780 units lost) and social housing (between 1995 to 2003: 82,900 units lost) have had an enormous impact. These stark realities have prompted Toronto, Ottawa and Durham Region municipal councils to declare homelessness a national disaster.
Homelessness is not just a “big city” problem; it is an issue throughout all Ontario communities. Approximately 1.5 million Ontarians spend more than 30% of their total household income on rent. By January 2004, Ontario had 158,456 households (approximately 300,000 individuals) on waiting lists for social housing of which 46.5% were families. In Ontario approximately 390,000 children live in poverty.
The reality of homelessness is complex. Multiple interconnected and interrelated determinants come together setting the stage for homelessness. Determinants include supply of affordable housing (gentrification), falling incomes (poverty), unemployment, social factors (which include substance abuse, lack of supports and services, prison release and mental illness), education, domestic violence and vulnerable groups (encompassing sex, race, socioeconomic status, disability and sexual orientation).
Homelessness precipitates an exponential increase in negative health consequences affecting Individuals, families and communities. Mortality, violence, mental illness and morbidityrates all elevate.
Managing and preventing these negative health consequences requires proper nutrition, acquisition of medication, storage of medication, adequate rest, hygiene and safety. These all pose serious challenges for homeless individuals.
Unfortunately, the relationship between the determinants and the outcomes of homelessness exist within a spiraling cycle where each subsequent event reinforces the former.
Circumstances may have induced homelessness but the ensuing challenges and outcomes render the climb out extremely difficult. In addition, discrimination, stigma, powerlessness and social disaffiliation shape the lived experience of homeless individuals and families.
Nurses must be aware of homelessness and basic housing needs in each facet of their practice. This should include all three dimensions of housing which include: house (physical structure), home (social and psychological characteristics) and neighbourhood (physical location and available services). Part of this process will require education and a reflective review of our own beliefs and practices surrounding homelessness.
Nurses also have a responsibility to educate the public and advocate on behalf of homeless individuals – for health. Since many determinants of homelessness are of a systemic nature, advocacy needs to extend to governments as well.
Ontario needs realistic and concerted efforts by all levels of government to reverse the trend of increasing homelessness and ultimately eliminate homelessness altogether. As a result, RNAO calls on governments to:
Homelessness is every Ontarian’s issue. Homelessness is every nurse’s issue. We can no longer speak out for health without speaking out against homelessness.
Please see the PDF version of this document  for footnotes and references.