1. PRESENTER TOOL – REVISED SUMMER 2013 HOUSING http://www.arsior.com/wp-content/uploads/2011/03/Healthy-home.jpg

2. HOUSING – OUTLINE (PREZI) Objectives TED Talk Housing and Health Housing as a social determinant of health Housing and the global context (MDG) Housing and the local context Housing and Primary Care Discussion / Activity

3. OBJECTIVES To be able to describe 3 ways in which housing affects health Be able to name the MDG that corresponds to housing Be able to describe to colleagues why an understanding of a patient’s housing is crucial in primary care

4. BECKY BLANTON: THE YEAR I WAS HOMELESS Becky Blanton planned to live in her van for a year and see the country, but when depression set in and her freelance job ended, her camping trip turned into homelessness. In this intimate talk, she describes her experience of becoming one of America's working homeless. Becky Blanton is a writer, photographer and former journalist who found herself homeless, but bounced back to tell her story and inspire others

5. BECKY BLANTON: THE YEAR I WAS HOMELESS During this TED talk, pay special attention to: What basic needs become more difficult when you are homeless The effects of inadequate housing on health

6. TED TALK http://www.ted.com/talks/becky_blanton_the_year _i_was_homeless.html

7. AFTER WATCHING THE TED TALK…. What basic needs become more difficult to address when you are homeless The effects of inadequate housing on health

8. HOUSING Why is housing important?

9. IMPORTANCE OF HOUSING Housing is important on many levels Housing fulfills physical needs by providing security and shelter from weather and climate It fulfills psychological needs by providing a sense of personal space and privacy. It fulfills social needs by providing a gathering area and communal space for the human family, the basic unit of society In many societies, it also fulfills economic needs by functioning as a center for commercial production. http://www.hrea.org/index.php?doc_id=411

10. http://severe-wx.pbworks.com/w/page/15957980/Blizzards%20and%20Cold%20Waves

11. http://www.colourbox.com/image/concept-photo-crime-robbery-theft-or-blackmail-in-the-street-image-2792945

12. http://organizesimplifyconnect.com/wp-content/uploads/family-in-the-kitchen-cooking-lg.jpg

13. http://en.wikipedia.org/wiki/File:Fireplace_Burning.jpg

14. http://www.hopnews.com/page3_138.html

15. http://www.cindysbedbreakfast.com/

16. HOUSING What basic needs are compromised when you’re homeless? (bathe, hold down a job, use your skills, feed yourself, stay warm/dry/cool, host friends, socialize, interact with people in a safe space, feel safe)

17. HOUSING How did not having housing impact upon Becky’s life and health? (bathing, weather, police, mental health, trying to be invisible, feeling as if no one cares –suicidality, showering, food production, taking care of pets)

18. IMPACT OF HOUSING What attitudes did Becky encounter as a result of being homeless? (negative perceptions from society, police, other homeless people)

19. HOUSING AND HEALTH Can you think of some examples (present day or historical) of how inadequate housing has an impact upon health? Cholera, TB, Diarrheal Diseases, Pertussis

20. http://recipehealth.net/wp-content/uploads/2012/07/cholera.jpg

21. http://newspaper.li/tuberculosis/ http://www.topnews.in/health/diseases/tuberculosis

22. http://www.ourbabynews.com/risk-of-diarrheal-disease.html

23. http://en.wikipedia.org/wiki/Pertussis

24. THE IMPORTANCE OF HOUSING – AN OLD IDEA (EXTRA) The following relates to an outbreak in New York over one hundred years ago: The real suffering of the poor is easily explained. They lived in the worst houses in the most crowded portions of the city and could not afford to flee when threatened by the epidemic. In New York, for example, it was not until death and public removal had thinned their ranks that the epidemic began to subside. Basement apartments were from six to four feet below the surface of the ground, and from these warrens came the “greater proportions and worst forms of cases.” NYC Board of Health, Reports of Hospital Physicians, 1832

25. IMPORTANCE OF HOUSING Historically cholera has been one of the most socially graded diseases and intimately related to housing http://www.topnews.in/health/haiti-cholera-toll-goes-724-29113 http://blogs.discovermagazine.com/discoblog/2007/06/27/victorian-doctors-not-as-dumb-as-you-think/

26. THE MANY EFFECTS OF HOUSING ON HEALTH http://journals2.scholarsportal.info.myaccess.library.utoronto.ca/show_image.xqy?path=annualreviews_backfiles_PUBLHEALTH/publhealth.2004.25.issu e-1/annurev.publhealth.25.101802.123036/graphic/pu250397.f1.eps

27. HOUSING AND HEALTH (PREZI) Homeless people are also at greater risk of premature death compared to the general population In the United States, being homeless can shorten life expectancy by 20 years (Wright et al., 1998) City of Toronto data show that young homeless men in Toronto are eight times more likely to die prematurely than men of the same age in the general population (Kushner, 1998) http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php

28. SOCIAL DETERMINANTS OF HEALTH

29. GLOBAL CONTEXT

30. MILLENNIUM DEVELOPMENT GOALS: WHERE DOES HOUSING FIT IN?

31. MILLENNIUM DEVELOPMENT GOALS

32. HOUSING - GLOBAL CONTEXT(MDG) GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY Target 7.C: Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation Target 7.D: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

33. HOUSING AND THE UNIVERSAL DECLARATION OF HUMAN RIGHTS (EXTRA) The right to housing is codified as a human right in the Universal Declaration of Human Rights: "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." (article 25(1)) http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php

34. HOUSING AS A HUMAN RIGHT “The human right to adequate housing is the right of every woman, man, youth and child to acquire and sustain a secure home and community in which to live in peace and dignity” http://www.hrea.org/index.php?doc_id=411

35. http://media.treehugger.com/assets/images/2011/10/20100125-haiti-earthquake-damage.jpg

36. HOUSING - LOCAL CONTEXT (PREZI) In 1986, the Ottawa Charter for Health Promotion (WHO, 1986) recognized shelter as a basic prerequisite for health It is only recently however, that researchers and policy-makers have focused on housing as an important determinant of health Housing insecurity can be determined by various indicators, including the number of people who sleep in the streets, use temporary shelters, live in substandard dwellings, and who spend more than 30% of their income on housing. http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php

37. HOUSING – LOCAL CONTEXT What makes someone “housing insecure”? How can we determine that someone does not have access to adequate housing?

38. HOUSING- LOCAL CONTEXT When rents are unaffordable, it is difficult to cover other necessities such as food, thereby contributing directly to food insecurity When families spend more than 50% of income on housing, it significantly reduces amounts that can be spent on recreation, food, and other social determinants of health http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php

39. HOUSING - LOCAL CONTEXT Canada Mortgage and Housing Corporation (CMHC) uses the term 'core need' to track the number of households unable to access adequate rental accommodation in their community. The term measures affordability, suitability of accommodation and adequacy. Households with core housing needs face one or more of the following issues: - Affordability : They spend more than 30% of their gross income on housing. - Suitability: They live in overcrowded conditions, i.e., household size and composition exceeds their actual home space requirements. - Adequacy: Their homes lack full bathroom facilities, or require significant repairs (Layton, 2000). http://www.phac-aspc.gc.ca/ph-sp/oi-ar/09_housing-eng.php

40. http://skuliavas.files.wordpress.com/2011/12/img_0151.jpg Attawapiskat Housing

41. HOUSING - LOCAL CONTEXT (EXTRA) “Do you remember what it was like growing up? Having a warm, welcoming home that always felt safe? A backyard to play in? Food in the fridge? At the time, you likely didn’t think about those things. No one could blame you for taking them for granted. Carefree; that’s how growing up should be. But life is not carefree for children of the 1.5 million Canadian families in need of safe, decent and affordable shelter. Many Canadian families live month to month, making it nearly impossible to get ahead. They’re forced to decide between heat and rent – a choice no family should ever have to make. Every Canadian family deserves a safe, decent and affordable place to call home.” Habitat for Humanity Canada

42. HOUSING AND PRIMARY CARE Primary health care refers to an approach to health and a spectrum of services beyond the traditional health care system It includes all services that play a part in health, such as income, housing, education, and environment Primary care is the element within primary health care that focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury

43. HOUSING AND PRIMARY CARE (PREZI) Why is it important for family doctors to know about their patient’s housing situation?

44. HOUSING AND PRIMARY CARE As family doctors we are in the business of preventative care and trying to create good health outcomes for patients It is therefore crucial for us to have a good understanding of the determinants of health Without understanding the factors influencing our patients’ health, it is difficult to have an impact upon their health Housing will greatly affect patients’ health and is therefore important for family doctors to address

45. HOUSING AND PRIMARY CARE Since housing has such a large impact on health, it is important for primary care practitioners to consider the housing needs of their patients Housing will affect patient’s physical, emotional and social well-being

47. DFCM CORE COMPETENCIES (EXTRA) Elicit information regarding the social situation of the patient Assess the impact of social conditions on the presenting symptoms Explore the patient’s cultural and social context including recent travel, lived experience and environmental factors to understand how these may influence the presentation of their symptom(s) Link patient’s symptom to their social situation and to a lifestyle behaviour and in doing so, employ the principles of disease prevention and health promotion and advocacy

48. ACTIVITY 1: HOUSING AND PRIMARY CARE (PREZI) Divide into groups of 3. List the various ways that we can advocate for patients and their housing needs

49. ACTIVITY 2 – REFLECTIVE WRITING Imagine you are homeless. Like Becky you used to have an apartment, a job, friends, and a family. Over the last year you have sunk into a depression, you have stopped working, you no longer see your friends, and you are unable to pay the rent. It is early September. Write about your first night sleeping out on the streets of Toronto, how do you feel, what are your fears, what possessions do you have with you, how does the world around you look?

50. http://www.openfile.ca/vancouver/blog/curator-blog/photo/2012/early-1970s-squatters-camp-coal-harbour VANCOUVER 1972

51. ACTIVITY 3: HOUSING What comes to mind when you see this picture? What basic needs would be difficult to meet if this was your living reality? What are the health consequences this living situation?

52. ACTION PLAN Group Discussion: After today’s workshop, make a list of tangible action plans to implement in your respective practices.