In public health, upstream thinking means focusing on the causes of illness to improve health outcomes. Standing beside a river, a person keeps jumping into the water to rescue a steady stream of distressed people floating downstream. Eventually, the person stops to consider “who is chucking these people into the river?” To get to the root of the problem, the helper must travel upstream. This VIDEO illustrates the point.
The sobering message we hear from almost every hospital CEO is that their hospital is ill-equipped and incapable of dealing with what is presented at the emergency room door day after day with people who are inadequately housed or having no home at all. In Hamilton, the situation is compounded by rising rates of mental health and addiction:
- Suicide and substance overdoses are among the leading causes of death among Hamiltonians under age 45.
- In 2015, there were 2,753 hospitalizations for mental illness in Hamilton
- The rate of opioid-related deaths in Hamilton increased by 326% between 2005 and 2018, making it one of the highest rates in Ontario
- Self-harm among female youth in Hamilton has tripled over the past decade.
With appropriate housing interventions, we move upstream to improve health outcomes while decreasing health care costs which continue to balloon, squeezing out needed investments in housing, education, and the environment.
Progress of the human condition is born of demonstration. The rights I presently enjoy as a privileged white woman are the result of active women who organized and agitated generations before me. The necessary work continues in extending these rights and more just conditions to all women.
There was a demonstration, with tents, outside of Hamilton City Hall in November of this year. Demonstrators were calling for action on affordable supportive housing and to draw our attention to the heightened risk of spending the winter outside without appropriate shelter. Protests are legitimate and bear witness to what can be overlooked and what is unjust. I support the right to protest. What I do not support is an action which sees the extension of a protest to the personal home of an elected official. It also distracts from the important issue of housing affordability. Case in point, I was called by a member of the local media to comment on a coffin, not housing insecurity.
I’ve heard criticism from some about the term “defund the police” and the practical implications of doing so. Call it what you will – a realignment of municipal resources to address community safety and well being - but upstream thinking is at its core.
In the late 1990s, the Government of Ontario under the leadership of Premier Mike Harris made a historically ill-advised decision that has affected the financial health of cities and the state of affordable housing in communities like Hamilton. Premier Harris downloaded the responsibility of affordable housing onto municipal property taxes. For older cities with higher poverty rates and ageing public housing stock, the financial hit was enormous and has created an unsustainable situation for many cities. The cost of new affordable housing is significant. Add to the ledger the inventory of ageing public housing stock that was built in the 1950s, 60s and 70s and there are reasons as to why the supply of affordable units has not kept pace with demand. Additionally, Canada was the sole industrial nation without a national housing strategy until 2017.
More and more policing will not eradicate homelessness nor address the mounting mental health and addiction crises befalling too many of our neighbours.
There is an urgency to act. It will require all levels of government coming together and acting in partnership with the private sector, our health services sector and all community housing agencies to address our housing crisis. It will require the fast-tracking of secondary dwelling units, bringing back inclusionary zoning and a greater commitment of our own city resources to leverage additional monies from senior orders of government. And, it will require the sustained support of voters.
Historically, social change rarely happens without a fight. It usually takes years of painstaking organization and activism to drive change and to convince others why change is necessary. There have been many agitators in the trenches raising the alarm about our growing housing crisis over the past number of years. They foresaw the consequences of downstream thinking and the impacts of underfunding. As an elected official I must listen to all voices, including those who are critical of me, as part of my commitment to our city and a more just future. Because Hamilton is worth our very best efforts.