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Michael Shapcott The Wellesley Institute CFMS, February 2014
Health and
your home
Res
earc
h an
d po
licy
inst
itute
???
Toronto 1911: Founding of
Wellesley Hospital
“The health of Toronto must necessarily mean the health of its citizens. It must mean, too, the continued progress and development of Toronto along desirable lines. ...but I fear, in all candour one must confess that this city, in common with every large city, has acquired inevitable ‘slum districts’... You will probably say: “But Toronto has few such areas and they are not of great extent!” I say, and I think you will agree with me, that Toronto wants none of them, and that the Toronto of the future which we like to contemplate will have none of them.” ! Dr. H.A. Bruce Lieutenant-Governor of Ontario 1934
Toronto
slum
s
trans
formed
into
good
homes
Equity, access, income and social determinants of health
Inequality
“After 20 years of continuous decline, both inequality and poverty rates have increased rapidly in the past 10 years,
now reaching levels above the OECD average.”OECD (2008), Growing Unequal? : Income Distribution and
Poverty in OECD Countries
Selected policy recommendations for OECD countries from Divided We Stand •Reforming tax and benefit policies is
the most direct instrument for increasing redistributive effects. Large and persistent losses in low-income groups following recessions underline the importance of government transfers and well-conceived income-support policies. •The growing share of income going to
top earners means that this group now has a greater capacity to pay taxes. In this context governments may re-examine the redistributive role of taxation to ensure that wealthier individuals contribute their fair share of the tax burden.
Toronto 1911: Founding of
Wellesley Hospital
OECD social expenditures
Canada 32nd out of 34
From poor to rich: Key household spending categories
Survey of Household Spending 2011
Systems thinking: How interconnections in complex, dynamic
world impact our lives and our health
Wellesley Urban Health Model
Practical proposals: The Mexico City Charter
Four observations: !!
1.Housing insecurity deep / persistent 2.Costly to people, communities,
economy, government 3.Federal housing / homelessness
investments eroding 4.No comprehensive national plan
Most housing
needs invisible
!
For renters, average market rents are outpacing renter household incomes
Canada Mortgage and Housing Corporation 2010
Bad housing makes you sick!Homelessness:
Increased morbidity Increased premature mortality
Mental health: Alarming rates... especially
Clinical depression and anxiety Control / meaning Collective efficacy
Homelessness: Homelessness:
Biological / physical: Chemicals, gases, pollutants Design (accidents) / crowdingSocio-economic:
Affordability / energy Transportation / income / jobs
Contextual: Individual / neighbourhood deprivation
networks / friends / crime
Good housing good for health!Physical and mental health:
Better health outcomes / decreased health care utilization
Community safety: Reduced recidivism among people leaving incarceration
Affordability interventions: Income-based housing subsidies
Environment / physical infrastructure: New housing, repairs, heating, noise,
indoor + outdoor environmental issues, allergens, water + sanitation
0.50%
0.60%
0.70%
0.80%
0.90%
1.00%
1.10%
1.20%
1989
19
90
1991
19
92
1993
19
94
1995
19
96
1997
19
98
1999
20
00
2001
20
02
2003
20
04
2005
20
06
2007
20
08
2009
Federal housing investments as a percentage of GDP)
Government Revenues and Expenditures 2009
SupplySupply
Federal housing investments (in millions)
Canada Mortgage and Housing Corporation 2012
$1,500
$1,750
$2,000
$2,250
$2,500
$2,750
$3,000
$3,250
2007
20
08
2009
20
10
2011
20
12
2013
20
14
2015
20
16
2017
SupplySupply
When the feds cut a dollar in housing investments… matching funds from
provinces, territories, municipalities, community and business are lost
450000
500000
550000
600000
650000
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
626,300 homes in 2007 492,500 homes in 2017 Loss of 133,800 homes
22% of entire stock
SupplySupply
Federally subsidized homes
Canada Mortgage and Housing Corporation 2012
Steve Pomeroy - Focus Consulting - 2012
Federal government reinvest savings gained from end of social
housing agreements into programs that will enable providers to maintain their units as social
housing