Improving Housing Conditions to Improve Health

This community engagement project tried to discern where legal interventions could have the most positive impact on the health and well-being outcomes of tenants by: 

• examining the needs, gaps and opportunities in health and housing research
• directly engaging with housing service providers and low-income tenants living with health-harming housing issues

The project was initiated and led by the Health Justice Program (HJP) – an organization that helps resolve legal issues that have a negative effect on patient health – along with several partners. HJP had an advisory committee made up of 13 members working in the housing, health and legal sectors to guide them.

Read the final report (PDF)

Project scope and expected outcomes

An obvious link between housing and health

Over the years, it’s become clear that housing issues are the number 1 reason for patient referral to the Health Justice Program. The link between housing and health is undeniable, as confirmed in the literature review undertaken for this planning activity. Moreover, medical-legal partnerships identified in the review are very effective at addressing tenants’ unmet needs.

Gathering insights from healthcare, housing and tenants

The team gathered insights through a literature review, data analysis and roundtable discussions. The discussions were with housing workers, St. Michael’s doctors, and tenants who are HJP clients. In the discussions, doctors and housing workers spoke about what they thought prevented patients from resolving housing issues. They also shared thoughts on which legal and non-legal services were working, and what needed improvement.

Tenants who are HJP clients offered their opinions on which services were successful in helping them resolve their housing issues. They also shared their impressions of the HJP and services that could be added to further help with housing.

Barriers to seeking help with housing issues

The discussions revealed 4 broad types of barriers that both tenants (HJP clients) and service providers identified:

1. confusing processes and lack of access to information for both tenants and landlords
2. intimidation, stress, frustration and fear of eviction, leaving tenants feeling disempowered and discouraged from reporting their housing issues
3. chronic health issues and disability, particularly related to mental health, which exacerbate housing issues
4. lack of capacity to support tenants at service provider organizations, and variations on quality of service

Overall, the state of a tenant’s health has a great impact on the ability and willingness to seek recourse for housing issues. It’s a vicious cycle: housing issues can cause or exacerbate health problems. Poor health makes it harder to seek help and deal with complicated bureaucratic processes.

Going forward: Ideas for medical-legal partnerships

Findings from the roundtables were provided to the Advisory Committee, HJP and St. Mike’s staff for further discussion. In these conversations, 5 ideas to better meet clients’ needs and improve existing services were proposed. These included:

1. Making the links between housing and health better known, especially to those within government.
2. Advocating for stronger mechanisms to support tenant health. This Includes:
   • addressing structural issues such as the lack of affordable housing
   • the rise in no-fault evictions
   • the need for more funding for social services
3. Improving education and awareness for tenants and landlords about housing and legal issues. Playing a greater role as a convenor and connector and being more visible and active in the community.
4. Providing and supporting professional development options for housing workers and health care providers. Offering workshops and training opportunities and facilitating gatherings to exchange ideas.
5. Expanding and enhancing existing service models, by advocating for better funding and creating more community partnerships.

Discussion

Overall this engagement exercise found that medical-legal partnerships like the Health Justice Program are effective. Still, several recommendations came out of the engagement exercise. One recommendation is that the St. Michael’s Hospital Academic Family Health Team embed a tenant-support lens into its care model. This would be in partnership with HJP and will take a more comprehensive look at the impact of housing.

Read the final report (PDF)