Toronto is experiencing a housing crisis with three major challenges: a lack of affordable housing, poor quality and inadequate social housing, and homelessness.
For too many Torontonians the lack of affordable homes means having to spend too much of their income on rent. Housing is considered unaffordable if it costs more than 30 percent of a household’s income. In 2010, 43.5 percent of renter households in Toronto exceeded this, leaving little in the budget for other essentials, like food, transit, and medicine.1 Not only is this unsustainable for many households, but it makes day-to-day life very difficult.
The inadequate supply of Toronto Community Housing (TCH) units is well-known. In June 2014, there were 92,241 households on the TCH waitlist, of whom 28,798 are households with seniors.2 Additionally, many TCH units are in need of urgent maintenance to make them safe and healthy. As of January, 2014, TCH reported that its capital repair backlog was $914 million and that $2.6 billion would be required over the next 10 years to maintain their units in a state of good repair.3
What’s more, Toronto’s homeless population continues to grow and shelters routinely operate at or near capacity.4 In 2013, the City estimated that 5,253 people were without a home, 447 of whom slept outdoors.5 Almost half of the people without a home reported being on a housing waitlist, including 19 percent who were waiting for supportive housing that specifically caters to mental health needs. Ninety-three percent reported that they wanted permanent housing.6
A health-enhancing housing plan would address housing unaffordability, increase the supply of TCH and other subsidized units, fund the TCH capital repair backlog, and commit to eliminating homelessness in Toronto.
Health Impacts of Housing
There is extensive evidence that living in poor quality or unsafe housing can have direct and indirect health impacts.7 For example, living in damp and moldy conditions can contribute to the development of respiratory conditions, like asthma.8 The connections between homelessness and poor health are also well established; people who are homeless are at greater risk of death and serious health problems like tuberculosis than the general population.9 Moreover, risk of homelessness is associated with other risk factors for poor health, like poverty and addiction.10
But a person doesn’t have to be homeless for housing to impact their health; housing affordability can also impact health. Housing is one of the largest expenses that most people face. There are strong connections between living in unaffordable housing – defined as costing 30 percent or more of a household’s income – and poor health.11 When housing takes up a large percentage of a household’s income, there is less money available for other essentials like healthy food, child care and transportation.12 Moreover, a lack of affordable housing can mean living in crowded situations, putting people at risk for infectious diseases such as tuberculosis and respiratory infections.13
Health Equity Impacts of Housing
Some populations are at greater risk of experiencing poor health owing to poor quality or unaffordable housing, including seniors, youth, newcomers, ethnic minorities and LGBT communities.14 People with low income or who are living in poverty are at particular risk of homelessness15 and are more likely to live in unsafe, inadequate or overcrowded housing arrangements.16 In Toronto in 2010, 19.3 percent of the population had income under Statistics Canada’s after-tax low income measure. Some sub-populations in Toronto experience even higher rates of poverty, including children aged under six years (25.6 percent) and youth aged under 18 years (25 percent). Additionally, 43.5 percent of renter households pay more than 30 percent of their income on housing.17 That number is far too high.
Children are particularly vulnerable to poor health outcomes that are related to housing and homelessness. Children can be especially sensitive to moisture and mold.18 Children who are homeless are more likely to experience asthma and ear infections, and have overall poor physical and mental health. Homelessness during pregnancy also results greater incidents of preterm delivery and low birth weight.19 Living in poor quality housing as a child may also contribute to poorer health over their lifetime.20
How do Toronto’s Leading Mayoral Candidates Measure Up for Equity in Housing?
||Note: Soknacki withdrew from the mayoral race on September 9th.
Housing for a Healthier Toronto
High quality and affordable housing is essential for good health. Despite this, neither Rob Ford nor John Tory have addressed housing issues in Toronto. Chow and Soknacki have housing policies, but they have not directly considered the health impacts of their proposals. Some of Chow and Soknacki’s housing policies, however, may have positive health benefits for Torontonians.
Chow and Soknacki would address the lack of affordable housing in Toronto through zoning changes. Both candidates have promised to expand inclusionary zoning, whereby developers would be required or incented to provide affordable housing in return for regulatory concessions.21 They would also make changes to existing zoning to facilitate the construction of more affordable housing in Toronto. Rezoning areas around existing residential towers to allow business activity and public spaces, as promised by Chow, may provide greater access to essential services such as grocery stores, mitigating the impact of living in poor housing. Soknacki would also lobby the federal government for additional affordable housing funding. Ford and Tory have not yet addressed the lack of affordable housing in Toronto.
Chow and Soknacki have similar policies on the decentralization of Toronto Community Housing Corporation governance to smaller, community-focused organizations. Evidence suggests that empowerment of tenants in social housing can lead to improvements in well-being;22 Chow and Soknacki’s proposals could therefore contribute to improved health for TCH tenants through increased social capital.
Soknacki has also committed to making administrative changes to reduce the TCH affordable housing waitlist and to fund state of good repair backlogs. Many of the 92,241 households on the TCH waitlist may be paying more than 30 percent of their income on housing while they wait for an affordable home, and some may be homeless. Given the connections between housing and health, reducing the TCH waitlist by facilitating access to affordable housing is critical. Likewise, Soknacki’s commitment to fund the state-of-good-repair backlog is also important to ensure that TCH residents have safe and healthy homes. Ford and Tory have not yet addressed social housing.
Soknacki has committed to creating a Mayor’s Homelessness Committee and has endorsed the Housing First model to address Toronto’s homelessness crisis. An evaluation of the Toronto component of the Mental Health Commission of Canada’s At Home/Chez Soi initiative to house people who were homeless and/or who had a mental illness showed that this program resulted in reductions in hospitalizations, health provider visits and emergency department and shelter use.23 Soknacki’s commitment to expanding eligibility for rent and utility supports for low income Torontonians may also prevent the negative health impacts of increased housing precarity and homelessness.24 Chow has committed to expanding Toronto’s emergency shelter capacity, which is currently running at or near capacity. Given that almost one-in-five homeless youth identify as LGBT, Chow’s commitment to dedicating 25 percent of youth shelter beds for LGBT youth is important. Ford and Tory have not yet addressed homelessness.
- City of Toronto, 2011 National Household Survey: Income and Shelter Costs, September 2013. Accessed Aug 15, 2014. http://www1.toronto.ca/City%20Of%20Toronto/Social%20Development,%20Finance%20&%20Administration/Shared%20Content/Demographics/PDFs/Reports/nhs-backgrounder-income-shelter.pdf. ↩
- Housing Connections, Monthly Statistical Report, June 2014. Accessed Aug 21, 2014. http://www.housingconnections.ca/PDF/MonthlyReports/2014/Monthly%20Report%20-%20June%202014.pdf. ↩
- Toronto Community Housing, State of Good Repair. Accessed August 26, 2014. http://www.torontohousing.ca/sogr_repair_needs. ↩
- City of Toronto, Daily Shelter Census. Accessed August 26, 2014. http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=4ec8c0e9f7301410VgnVCM10000071d60f89RCRD&vgnextchannel=c0aeab2cedfb0410VgnVCM10000071d60f89RCRD. ↩
- City of Toronto, 2013 Street Needs Assessment Results, 2013. Accessed August 26, 2014. http://www.toronto.ca/legdocs/mmis/2013/cd/bgrd/backgroundfile-61365.pdf. ↩
- City of Toronto, 2013 Street Needs Assessment Results. ↩
- S. Hwang & K. McKenzie, ‘Ontario’s housing crisis is also a health crisis’, The Toronto Star, July 6, 2014. Accessed August 27, 2014. http://www.thestar.com/opinion/commentary/2014/07/06/ontarios_housing_crisis_is_also_a_health_crisis.html. ↩
- J.R. Dunn, ‘Housing and Health Inequalities: Review and Prospects for Research’, Housing Studies 15(3), May 2000. ↩
- S.W. Hwang, R. Wilkins, M. Tjepkema, P.J. O’Campo & J.R. Dunn, ‘Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study’, BMJ 339, 2009; Dunn, 2000. ↩
- Toronto Public Health, Healthy Toronto by Design, Toronto, October 2011. ↩
- Dunn, 2000. ↩
- S.I. Kirkpatrick & V. Tarasuk, ‘Housing Circumstances are Associated with Household Food Access among Low-Income Urban Families, Journal of Urban Health 88(2), 2011. ↩
- J. Krieger & D.L Higgins, ‘Housing and Health: Time Again for Public Health Action’, American Journal of Public Health 92(5), 2002; S. Pathak, M.D. Low, L. Franzini & J.M. Swint, ‘A Review of Canadian Policy on Social Determinants of Health’, Review of European Studies, 4(4), 2012. ↩
- A. Mahamoud, B. Roche, B. Gardner & M. Shapcott, Housing and health: Examining the links, Wellesley Institute, March 2012. ↩
- C. Chamberlain & G. Johnson, ‘Pathways into adult homelessness’, Journal of Sociology 49(1), 2011. ↩
- Kirkpatrick & Tarasuk. ↩
- City of Toronto, 2013. ↩
- D.C. Read and A. Tsvetkova, ‘Housing and Social Issues: A Cross Disciplinary Review of the Existing Literature’, Journal of Real Estate Literature 20(1), 2012. ↩
- Ibid. ↩
- D. Raphael, ‘Poverty in childhood and adverse health outcomes in adulthood’, Maturitas 69, 2011. ↩
- R. Drdla Associates, A Guide to Developing an Inclusionary Housing Program, September 2009. Accessed Aug 21, 2014. http://www.wellesleyinstitute.com/wp-content/uploads/2010/06/Inclusionaryhousing_Drdla.pdf. ↩
- J. Rosenberg, ‘Social Housing, Community Empowerment and Well-Being: Part One – Empowerment Practice in Social Housing’, Housing, Care and Support 14(4), 2011. ↩
- V. Stergiopoulos, P. O’Campo, S. Hwang, A. Gozdzik, J. Jeyaratnam, V. Misir, R. Nisenbaum, S. Zerger, & M. Kirst, At Home/Chez Soi Project: Toronto Final Report. Calgary: Mental Health Commission of Canada, 2014. ↩
- Concerns about eligibility for municipally-administered emergency housing funds are discussed in B. Gardner, S. Barnes & J. Laidley, The Real Cost of Cutting the Community Start-Up and Maintenance Benefit: A Health Equity Impact Assessment, Wellesley Institute, November 2012. Accessed Aug 15, 2014. http://www.wellesleyinstitute.com/wp-content/uploads/2012/11/The-Real-Cost-of-Cutting-CSUMB.pdf. ↩