Kate Mason
Homelessness in Toronto 32,000 different people use a homeless shelter in Toronto each year City of Toronto Street Count 5,052 homeless individuals (April 2006) Homeless people have poor health, high mortality rates and difficulty accessing health care
Study background Follow-up to the 1992 Street Health Report 2007 Survey: representative, random sample of 368 homeless men and women at meal programs & shelters across downtown Toronto Qualitative interviews and photographs with a sub sample of 28 (NFB) Homelessness defined as: having stayed in a shelter, with a friend, in a public place, or other site not intended for human habitation for at least 10 of the last 30 nights
Community Involvement Peer researchers: data collection, analysis and dissemination Community Advisory Committee Key study partners: Wellesley Institute, CRICH - St. Michael s Hospital, National Film Board
Demographics 26% female: 73% male: 1% trans Average age 42 years 77% born in Canada (32% born in Toronto) 72% had lived in Toronto 10 years + 37% non-caucasian Average years homeless: 4.7 70% homeless 1 year or more
Daily living conditions 50% have incomes < $400/month 52% not getting welfare, disability or any substantial government support 55% of shelter users had not been able to get a bed at least once in the past year 69% reported being hungry at least one day/week 35% physically assaulted in past year 12% assaulted by police in past year 21% of women raped or sexually assaulted in past year
Physical health status 74% had at least one of 22 serious physical health conditions*. 52% had two or more *includes: cardiovascular and respiratory diseases, hepatitis and other liver diseases, gastrointestinal ulcers, diabetes, anemia, epilepsy, cancer and HIV/AIDS
Health Condition Street Health Survey General Population Arthritis 43% 14% Hepatitis C 23% 0.8% Asthma 21% 6% Heart disease 20% 4% COPD 17% 1% Ulcers 15% 2% Diabetes 9% 4% Epilepsy 6% 0.3% Cancer 4% 1% HIV+ 2%.006%
Mental health status 56% experienced serious depression in past year 55% experienced serious anxiety 40% had seriously considered suicide in their lifetime; compared to 7% of people in Toronto 10% had tried in the past year
Drug Use 59% used an illicit drug other than marijuana regularly (3 + times/wk) in past year 16% had injected drugs in past year Most commonly used substances: Crack - 49%; compared to 1% of Toronto population Marijuana - 48% Cocaine - 30% Prescription opiates - 31% Heroin - 7%
Health Care Access Source of Health Care Use in past year Average # of times Emergency department 54% 5 Doctor s office 44% 12 Shelter, drop-in, health bus 42% 15 Community health centre 31% 11 Walk-in Clinic 29% 4 Hospitalized at least 1 night 24% 2 Hospital Outpatient Clinic 13% 9
Primary Health Care 34% do not have a usual source of health care or use hospital emergency departments as their usual source of care 59% do not have a family doctor; compared to 9% of the general population of Toronto Fewer report having a family doctor (20% less) than in 1992
Barriers to health care 34% do not have an Ontario Health Card 28% refused health care in past year due to lack of health card 40% experienced discrimination from a health care provider in past year 33% not able to follow health advice or treatment plan in past year
Recommendations Series of recommendations based on our findings focused on 4 key areas: Addressing poverty Improving access to housing Improving the living conditions of people who are homeless Improving access to health care
Dissemination & Advocacy Report release event Distributing the report Media coverage Public presentations Meetings with politicians and policy makers
Study Impact Health care sector has been the most responsive Immediate benefits for peers and partnerships Tool for other community groups Role in keeping decision makers convinced and on-track
Next Steps Continued use of existing data to create a series of research bulletins: Hepatitis C and access to health care Women Aboriginal people Concurrent Disorders Policy and advocacy work on focused issues
Acknowledgements The Wellesley Institute The Metcalf Foundation The United Way of Greater Toronto HRSDC - Homelessness Partnering Secretariat Canadian Institutes of Health Research - ICE Grant Ontario Trillium Foundation
The Street Health Report 2007 Available at: www.streethealth.ca Kate Mason: kate@streethealth.ca Street Health Stories film Available on You Tube www.nfb.ca/filmmakerinresidence