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Dr. Turnbull's PresentationAbout Healing Homelessness in Ottawa(adapted for website)
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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”