Housing as a social determinant of health: a recipe for disaster is cooking in Saskatchewan

Guest blog by Dr. Manuela Valle-Castro, Director, Division of Social Accountability

On October 22, Saskatoon community-based organizations that deliver front-line services to people living in poverty―Quint Development, the Lighthouse, the Elizabeth Fry Society, Prairie Harm Reduction, OUT Saskatoon, the Saskatoon Poverty Reduction Partnership, the Westside Community Clinic, and the Saskatoon Housing Initiatives Partnership, among others―met at Station 20 West in an emergency community meeting to discuss the impacts on their clients of recent changes in social assistance.

They described a situation in which nonprofits are forced to compete with each other for scarce funds to deal with “Band-Aid” programs to address complex social problems, like poverty and homelessness, that are rooted in colonial policy, such as the reserve system and residential schools. They denounced the lack of provincial social support as a situation of “systemic neglect” to the most vulnerable. Almost 85 per cent of homeless people are Indigenous[1]; many are residential school survivors; and many face severe health problems. For example, complications from diabetes lead to amputations, which in turn leaves people facing more barriers.

These clients are not supported to stabilize, throwing them into a cycle of housing crisis, eviction, and homelessness. The provincial government does not fund shelters for people if they are intoxicated, leaving those who are homeless and living with addictions to extreme suffering and sometimes death in the winter, as happened last year to the late Kimberly Squirrel.

The biggest casualties of this systemic neglect are the children of these families. Lacking adequate housing leads to family instability and results in too many Indigenous children disproportionately going into foster care (86 per cent of children in foster care are Indigenous in Saskatchewan). Family disruption is one of the main predictors of incarceration, poverty, overall poor health and short life expectancy.

The failure of our social systems to properly and proactively address these inequities is not just socially and politically unsustainable, but it also results in an extra burden for the health care system and law enforcement. It is economically unsustainable.

We are teaching our students that physicians have a role in advocating for the social determinants of health of a community. We teach them that housing and food security, along with the right to a clean environment are crucial for any individuals’ health. But physicians and their professional associations need to speak up and educate our provincial authorities on the impacts of clearly bad policy on the health of our communities, and on the unnecessary burden that housing insecurity and homelessness puts in our healthcare system.

According to the Royal College of Physicians and Surgeons of Canada:

Physicians are accountable to society and recognize their duty to contribute to efforts to improve the health and well-being of their patients, their communities, and the broader populations they serve.* Improving health is not limited to mitigating illness or trauma, but also involves disease prevention, health promotion, and health protection. Improving health also includes promoting health equity, whereby individuals and populations reach their full health potential without being disadvantaged by, for example, race, ethnicity, religion, gender, sexual orientation, age, social class, economic status, or level of education.

Social accountability means that medical schools also have a mandate to prioritize the health concerns of the communities where they are located, as well as to prepare students with a deep understanding of those health issues so they can effectively address them. Our college has taken on a moral and ethical responsibility to address the health disparities that affect Indigenous peoples and children when we put on our orange shirts and declared that “every child matters” on September 30. Let us live up to it.


[1] “2018 Point-In-Time Homelessness Count Saskatoon, Saskatchewan” https://static1.squarespace.com/static/58dd630f3a0411286bd918ad/t/5d11464216f1d70001dfc3da/1561413186855/PIT+Count+2018+Report-web.pdf?fbclid=IwAR3hyap3K0WbTXzfmoT8fZCkacX_7qrbDvc3dtrsdYvE3dU2Bv6HT7NIzPs

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