“Health” requires more than health care for people in supportive housing

We read with interest the article “Health care in supportive housing facilities”[1] by Dr Gibson and colleagues, published in the May issue of the BC Medical Journal. While we share the authors’ concerns about barriers individuals in supportive housing face in meeting their health needs, we believe the article’s conclusions could have gone further toward setting the stage to address the complexities that are discussed in the paper.

In 1948, the World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[2] As such, an exploration of health needs in the context of access to doctors and health services in supportive housing fails to live up to a more holistic understanding of health and well-being.

As the authors state, “housing alone can be insufficient in supporting individuals with complex health needs.” Also noted in the article, individuals living in supportive housing can face a multitude of barriers, such as a lack of ability to navigate services, physical challenges, issues related to transportation to get to appointments, stigma and discrimination, the need for assistance with activities of daily life, and an overall lack of coordination between health and housing providers.

But achieving placement in supportive housing in the first place can be a long process. Individuals’ health continues to deteriorate while they wait, increasing the complexity of their needs once they are finally housed.

Once attained, housing can be a therapeutic intervention when social support and specific environmental conditions are met. Many individuals value a sense of connectedness and belonging as a priority—more than a roof in some cases—and a sense of community can be enhanced through purposeful and coordinated approaches across a number of providers. Strengthening a sense of belonging, connectedness, and unity is a positive attribute of housing and community that is conducive to health.

Homelessness is a growing concern in BC. According to the latest point-in-time count published by BC Housing, the number of individuals experiencing homelessness increased by 11.5% in 2021 (compared with 2018), and over 40% of homeless individuals identified as Indigenous.[3] As one of the fastest-growing metropolitan areas in Canada in 2021, Kelowna has seen a rapid increase in population and an escalating demand for health, shelter, and social services.[4]

Addressing the current and future health needs of marginalized individuals, such as those at risk of or experiencing homelessness, particularly in rapidly growing communities like Kelowna, requires a broader vision that transcends health care and is inclusive of social change aimed at overcoming the determinants of inequities that negatively impact individuals’ health. There is an opportunity to consider revisiting power relations, reconciliation with Indigenous peoples, and decision-making structures. Ultimately, new partnerships are required to foster social inclusion and community participation and to develop strategies to address health inequities.
—Michelle Hawkins, BSc (Hons)
—Silvina C. Mema, MD, MSc, FRCPC

This letter was submitted in response to “Health care in supportive housing facilities.”


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1. Gibson H, Evans M, Woodmass K, et al. Health care in supportive housing facilities. BCMJ 2023;65:116-121.

2. World Health Organization. Constitution of the World Health Organization, 1946. Accessed 11 May 2023. www.who.int/about/governance/constitution.

3. Homelessness Services Association of BC. 2020/21 report on homeless counts in BC. December 2021. Accessed 1 October 2022. www.bchousing.org/sites/default/files/media/documents/2020-21-BC-Homeless-Counts.pdf.

4. Statistics Canada. Infographic 1: Among Canada’s downtowns, the population is growing the fastest in those of Halifax, Montréal and Kelowna. Modified 9 February 2022. Accessed 11 May 2023. www150.statcan.gc.ca/n1/daily-quotidien/220209/g-b001-eng.htm.

Michelle Hawkins, BSc (Hons), Silvina C. Mema, MD, MSc, FRCPC. “Health” requires more than health care for people in supportive housing. BCMJ, Vol. 65, No. 7, September, 2023, Page(s) 239,241 - Letters.

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