the cities issue Life on the City Streets
Does housing make the homeless healthier?
Stephen Hwang explores the nuances of an “incredibly complex problem” by Paul Fraumeni
the research findings are clear — people who are homeless in our cities have more and worse health problems than people who are in better circumstances. This has been proven by U of T professor and St. Michael’s Hospital clinician and scientist Stephen Hwang and others through numerous studies.
“Homeless people have a higher prevalence of mental illness, addictions and a variety of physical health problems that are often inadequately treated or controlled,” says Hwang. “And they suffer from a high level of disability at a prematurely early age.”
But that information leads to a difficult question: do health problems cause these people to become homeless or did their state of being homeless cause them to have the health problems?
“It’s a vicious cycle that includes both forces,” notes Hwang. “Homelessness is an incredibly complex problem.”
Understanding that complexity has been at the core of Hwang’s work since he joined St. Michael’s in 1996 to spearhead the Centre for Research on Inner City Health. Hwang is one of a growing number of researchers and policy makers who emphasize that homelessness is the result of many factors in society — and that helping to get people out of a homeless state can only be accomplished by pulling the problem apart from many angles.
Hwang’s investigation into homelessness is not theoretical. He is a physician who treats homeless men at Seaton House, the largest homeless shelter in Toronto. He uses the front-line knowledge he gains in this work to inform his role as a scientist and U of T professor in the Department of Medicine and the Dalla lana School of Public Health. Early in 2013, St. Michael’s appointed him as its inaugural chair in homelessness, housing and health.
Hwang and colleagues across the country are currently conducting a mammoth project called At Home/Chez Soi (AH/CS) that is testing intervention methods to meet the needs of homeless people with mental illness in five Canadian cities.
Working from a model called Housing First that has been tried in the United States, the AH/CS initiative is founded on a key principle, says Hwang: “Housing is a first step to enabling a person who is homeless to achieve better health.”
And essential to the transition to improved health is a major next step after quality housing has been provided — appropriate supports in the community. “This is a fundamental realization that has changed the way we think about treating people who are homeless. Provide housing and then work with them to help them achieve their goals. This allows people to realize, for example, ‘OK, now that I have housing, my goal is to not use crack every day.’ Through research, we know that once people have a house, they realize there is a possibility for changing their lives. Having hous- ing makes that possible.”
Hwang notes that getting people housing and support is an important first step in a long road of change. “We see small, gradual improvements rather than miraculous transformations. There is no panacea. But change for these individuals is absolutely possible and real.”