The Complex Connections between Homelessness and Health Inequities in BC

On January 26th, 2021, KHRC’s Dr. John Graham and Dr. Silvina Mema participated in an insightful discussion with other local experts on the intersectionality of homelessness and health inequities, covering a range of implications for researchers, service providers, and the community at large. A big thanks to Alumni UBC and the UBC Faculty of Medicine for hosting such a great event! More information on the presenters as well as links to any resources identified during the webinar can be found on the Alumni UBC event page.

After the event, Drs. Graham and Mema provided some additional thoughts on the topics that were addressed, as well as where the conversation might lead next.

The Q&A portion of the webinar featured a discussion on the actions the medical community can take to assist patients experiencing homelessness. Dr. Mema, you raised the importance of advocacy and action in the face of perceived injustice. You also discussed how addressing social determinants of health helps decrease the “health gradient”. These complex, intersecting factors clearly warrant equally multifaceted and collaborative responses.

On that topic of intersectoral action, do you have thoughts on what the non-medical community can do to support health factors (be that other service providers, or the community at large)?

Dr. Mema:

I think we need to be mindful that the stigma around mental health, substance use, and homelessness is another added social factor that can make this “ramp” steeper for vulnerable individuals. The public’s opinion is also what ultimately dictates the priorities of local, provincial, and federal governments. Accordingly, I think it’s important to appreciate the positive potential of actions that promote awareness and education of the general public. Presenting authentic and informative narratives around overcoming homelessness and associated barriers and vulnerabilities may go a long way in this regard. The medical and non-medical service systems can support these advocacy activities.

Dr. Graham:

One of the major difficulties in Kelowna is the siloing of functions amongst health, child welfare, substance misuse, and other agencies that serve the homeless population. Anything that can be done to further reduce silos would be nothing but helpful. This includes data sharing and collaborative planning to further align services and priorities.

Can you speak to how individual providers can be mindful of the myriad of interdisciplinary factors and associated solutions? Does that rely on internal education and review, building strategic partnerships, or all of the above?

Dr. Mema:

It’s all of the above. Individual providers from a diverse cross-section of the system should be involved in the development of strategies and the planning of services for the populations they support. We should be mindful that service providers in all areas – and like all members of society – have limited time and resources as well as their own individual perspectives, beliefs, and blind spots. Therefore, we should also always be open to collaborative learning to better the services and strategies that we implement. That applies equally to the supports for clients as it does to providers, recognizing that addressing this complex challenge of homelessness can trigger burn out and compassion fatigue.

Dr. Graham:

Continuing professional education is always an important mechanism for promoting best practice and well as for engaging one’s workforce. At the UBC Okanagan School of Social Work a further platform of post-degree continuous learning is expected to be launched later in 2021. Further details to follow.

The discussion also covered the importance of Lived Experience / Peer perspectives. Dr. Mema, you provided some great commentary on the system perspective and the important of acknowledging that the system doesn’t have all the answers. You spoke of the need to consult the population themselves, to hire those with lived experience, to train those individuals to speak the language of the system to be able to effectively voice their perspectives, and then of course to allow these perspectives to influence action. You noted the hiring of peer coordinators within the local Health Authority as one example of steps in a positive direction, and the overdose crisis was a particular turning point in consultation and collaboration.

Can you expand on that local context of how responding to the overdose crisis identified the benefits of peer coordinators?

Dr. Mema:

I have noticed a very quick shift in recent years in favor of deeper engagement with people with lived experience. As we connect with people with lived experience of substance use in the context of the overdose crisis, we learned that stigma and criminalization were key obstacles to overcome. We also engaged with family members of individuals affected by overdose regarding their needs. Peer coordinators can help advance a harm reduction, anti-stigma agenda. They are experts in their own right and their voice is very important in the context of planning for services.

Dr. Graham:

I agree with Dr. Mema here and in her other thoughtful responses, and from a research perspective would highlight the value of Lived Experience in guiding the recent KHRC work on vulnerabilities leading to homelessness as well as upcoming work on the broader topic of allyship in research (see: Current Initiatives).

In terms of de-siloing, it has been acknowledged that in many domains COVID has forced us to work together, fostered honest discussions, but that the challenge will be to sustain good practices and continue on this path. Dr. Graham advanced the particular option tying collaboration to funding as one mechanism for promoting de-siloing.

Do you have any additional thoughts on the sustainability of collaborative practices? Broadly speaking, and/or in relation to funding?

Dr. Graham:

The best way to de-silo the sectors relevant to the homeless populations is to create funding mechanism that prioritize collaboration. This could be done at the front end in terms of funding criteria, promoting partner-based applications, as well as in the reporting required by the funder at the review stages.

Dr. Mema:

I agree with the comments that Dr. Graham raised during our discussion — the funding is often siloed and thus the associated processes and services related to those funding streams are equally siloed. Homelessness is a complex problem that requires alignment across sectors.

This discussion touched on a broad range of topics and perspectives – I’m sure all those in attendance appreciated the complexity of the situation and hopefully some optimism in the potential impact of informed, collaborative action.

Where would you like to see the conversation move next, locally or at higher levels of policy and planning?

Dr. Graham:

It might be useful to have meaningful, high level conversations amongst municipal leaders, provincial authorities such as BC Housing, Interior Health, MCFD, and other auspices – with an endgame of identifying and committing to collaborative processes and measurable outcomes.

Dr. Mema:

I think that local governments are strategically positioned to lead and advocate for some of this work.

What do you see as emerging challenges in this area?

Dr. Graham:

Again, I’d highlight the risks of siloing and stasis at this critical juncture if we truly want to meet our targets and commitments. I’d also highlight a need for greater community engagement and community capacity building; I believe there’s a both shared desire and capacity within members of the broader public to support their vulnerable neighbours. It’s just a matter of finding the right way to promote a positive narrative around these issues as well as identifying appropriate mechanisms for the involvement of diverse stakeholders.

Dr. Mema:

I would echo the limitations inherent to working in silos, particularly given the complex nature of the problem at hand. Part of this is associated with the finite nature of resources paired with limited incentive and support for collaborating across sectors.

What are some emerging developments that give you hope?

Dr. Mema:

Moments of crisis bring with them opportunities to rethink the status quo and advance issues for innovation and action. The pandemic has shed further light on the inequities within our society and I think this is the time for us to advocate to improve the circumstances of vulnerable people.

Dr. Graham:

Everyone would like to see an end to homelessness. I think that’s a shared sentiment among the many dedicated individuals working in our community in support of our vulnerable community members. To that end, we need to put all relevant oars in the water. I look forward to participating in subsequent discussions on how we can continuously leverage that into collective and collaborative action.

For more information on the topic health and homelessness, see the resources listed on the Alumni UBC event page.