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Thursday, 15 December 2011

Housing as a novel solution for homelessness - Happy holidays

Tis the holiday season, and for most of us that means family, friends and fun.  Time to be thankful for the pleasures we enjoy.   As we enjoy our festivities in warm company, we will hardly think twice about the roof over our heads or the cold outside. 
It is the time where countless generous volunteers for brief times will provide service and aid to those not able to enjoy basic comforts. For some the warmth of generosity of placing some coins into a basket at a mall is calming charity.  It is the time of the season that the impact of homelessness strikes home the hardest for those without shelter or those living in vulnerable housing situations where a choice between warmth in turning up the heat is balanced with food on the table. 
This blog has touched previously on housing Sept 20 2011.   This week, Health Evidence released a review on the health benefits of housing that is well worth reading.  Housing summary statement Health evidence.ca .   The relative dearth of information on benefits and harms, long term impacts, directed shelter benefits for women and children speaks to the ongoing need for directed and channelled research in this area.
The review mentions the estimated 17,000 shelter beds and the nearly 10,000 persons in Canada who nightly are still considered homeless. It weighs the evidence on what efforts should be undertaken to address their basic needs and perhaps reduce the health burden that they carry, and the burden on the health care system.  
Hospital administrations should take note before expanding far more expensive services.   Emergency departments should be pleased that the report suggests a reduction in emergency room utilization.  A reduction in psychiatric inpatient days was also noted.  The impact on other hospital resources appeared mixed, and possibly because of the 20% increase in mortality amongst homeless with HIV who likely avoided in-patient care – a poor excuse for describing the impact on hospital utilization as mixed.  Nonetheless the significant impacts on health care resources provides ample justification for health jurisdictions to be actively involved in advocating for housing as a health intervention.
Commendably as well, the review sneaks in that upwards of 400,000 Canadians live in vulnerable housing situations and notes that the health profile of this group is similarly poor to those that are homeless.
The review places considerable emphasis on the issues of abstinence versus non-abstinent housing options.  It would be well worth a careful methodological review to segregate the biases inherent in resolving such a question, and what outcomes are being sought.   The review suggests outcomes only in the 1-2 month time frame while persons arguing in favour of non-abstinent housing interventions will suggest that addictions are often secondary issues that can only be addressed after primary issues are managed and longer term benefits are achievable.
There are as many questions as answers, and applying “evidence” can take us down inappropriate paths when the real life questions are not answered.  Those real life questions also tend to be messy to answer using rigorous research methodologies that stand up to the expectations of the Cochrane panels.   There is currently a large scale study in Canada looking at randomization of housing options for the homeless to measure health impacts which will be exciting to view the final reports.
The Ottawa Charter on Health Promotion clearly identified shelter as a pre-requisite for health.  Yet 25 years later, we continue to debate the science about whether it truly is.  This Health Evidence review at least suggests some value in seeing housing as a solution for homelessness. 
DrPHealth will take a brief vacation from routine postings.  This reflects a large reduction from an average 50 visits to 15 during this week, and no doubt reflects the opportunity of followers to enjoy the holiday season.  So from the tips of our fingers, through this posting, we wish you the best of the holiday season, safe and healthy times, and shall look forward to a joyous 2012. 

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