Homelessness is a health and safety risk: Why we need a public health approach in tent cities
by The Undersigned
August 11, 2018
Close to 500 residents of Discontent City in Nanaimo, Anita Place in Maple Ridge, and Camp Namegans in Saanich, BC are facing the threat of displacement largely on the basis of health and safety concerns, often focused on fire safety to the exclusion of other health and safety risks.
Persistent homelessness, visible in the presence of tent cities throughout Canada and particularly in BC, highlights the failure of society to ensure basic human rights and access to the basic determinants of health such as food, water, housing, social supports, self-determination, and freedom from violence and discrimination enshrined in international agreements including the International Covenant on Economic, Social and Cultural Rights. 
Yet, residents of these tent cities have repeatedly claimed that living in tent cities, in the absence of other acceptable options, improves psychological and physical health including community belonging, autonomy and self-determination. We call on all governments to shift from using public health as a rationale to displace tent cities to adopting a public health approach that treats fire safety as one factor amongst others to reduce public health and safety concerns associated with homelessness.
Overemphasizing fire safety can obscure and exacerbate other harms
A frequent and reoccurring issue related to tent cities is that of safety with often increasing concerns related to fire safety, public order and public health hazards. In BC, in summer, fire hazards are elevated across the province. For people who are homeless, the risk of fire is added to other risks of being homeless such as violence, assault, lack of stable housing, food and food storage as well as resultant health issues.
The risk of fire exists whether people live in unsheltered settings alone or in tent cities. The “solutions” to these fire risks in tent cities across the province has been legal actions and fire orders often with conditions that can exacerbate the harms of homelessness.
For instance, in Discontent City, the fire order includes a “no tarp” condition which increases exposure to heat for tent city residents. A temperature reading of a tent with and without a tarp recently showed a 5-degree difference, the latter making the tent 40 degrees Celsius. While it is in the interests of everyone to manage fire risks, banning tarps is something we would never dream of doing in a BC Parks campsite.
Homelessness is not a consequence of bad choices but a consequence of bad policies including withdrawal of funding from social housing, privatization of the housing market, erosion of the social safety net, and colonization that has stripped Indigenous people of opportunities, land and resources. As well, there are systemic gaps when people exit corrections, health care, and foster care and gaps between health and social systems.
The risks of fire and public disorder are often powerful narratives that fail to recognize the reality of the situation in which tent cities emerge and the conditions in which people live and the lack of access to safe, acceptable and affordable housing and inadequate incomes needed for a decent standard of living. The public health hazards are a lack of adequate shelter, safe drinking water, sanitation, food, and food storage as well as adequate structures to protect people from the elements and environmental hazards. All of which threaten the health of camp residents.
The Ottawa Charter: Five Principles of a Public Health Approach
International rights to housing and health including the International Covenant on Economic, Social and Cultural Rights  uphold access to adequate physical structures with safe drinking water, heating and lighting, sanitation, food storage, site drainage, energy for cooking and access to emergency services, security of tenure, affordability, and habitability (livable in terms of protection from weather and potential threats to well-being, accommodate special physical needs with accessibility to services and built with respect to cultural identity and diversity). In addition to this, the International Covenant on Political and Civil Rights  lays out the importance of self-determination and being able to obtain an adequate standard of living without discrimination.
Public health aims to improve conditions in which people can be healthy through health promotion, health protection, and disease and illness prevention. Canada is a world leader in population health and public health. The Ottawa Charter  is an internationally recognized public health framework consisting of five principles meant to guide action to promote the population’s health and well-being. In the absence of affordable and appropriate housing, we, the undersigned, call on the provincial government to adopt a public health approach to tent cities in BC by adopting the following five principles:
Build Healthy Public Policy - Healthy public policy means ensuring that all citizens have access to decent housing that is acceptable, culturally appropriate and at a cost that they can afford given minimum wage earnings and/or social assistance rates. In the absence of implementing evidence-based responses to homelessness, municipal governments should not construct bylaws that unfairly restrict the ability of homeless people, including those living in tent cities, to erect permanent shelter to protect themselves from the elements and provide a measure of safety and stability.
Create environments which support healthy living
Recognizing that people who are homeless do not have access to the basic determinants of health, environments should be organized in a way that does not create or contribute to poor health, and instead, improves it. Health protection measures include ensuring access to a safe quality and quantity of water, waste removal, food (including food storage, cooking areas, and refrigeration), hygiene, prevention of communicable disease, pest control, and measures to protect against exposure to cold and heat, electricity, and fire prevention- in other words, just what we all want and need. Health promotion measures include immediate housing placement offered with options, income and disability assistance as needed, and employment assistance if requested. Governments and all organizations should be working with and assisting all homeless people, including maximizing the opportunities for increased health protections possible in tent cities as well as working towards permanent solutions.
Strengthen community action on health - Communities themselves must determine what their needs are and how best to meet them. We must ensure that tent city residents maintain autonomy and self-determination over their homes and lives while also gaining access to health, social and public safety services. Governments and all organizations should work with tent city residents to meet their health and safety needs as well as to develop long-term solutions.
Help people develop their skills – so that they can have more control over their health. Governments and all organizations should work with people in tent cities to comply with various safety requirements including safety orders as well as encouraging and supporting the development of peer workers in the provision of health and other services.
Reorient health systems - to promote a better balance between health promotion and curative services. Governments and all organizations should ensure that health services for tent cities focus on promotion, prevention and restorative services and include an emphasis on the inclusion of peer workers. Basic health services available to camp residents should include primary care (management of acute and chronic health conditions, wound management, immunizations, screening and assessments); mental health and harm reduction training and support (overdose management and prevention; sterile supplies); and first aid training.
A public health approach means working with residents to implement evidence-based approaches to ending homelessness rather than legal proceedings which are not evidence based, diverting resources and energy from public health solutions and even increasing harms.
Bernie Pauly, Nursing, University of Victoria
Marilou Gagnon, Nursing, University of Victoria
Chrissy Brett, Nuxalk Nation, Founder of Camp Namegans
James Frankish, Population and Public Health. University of British Columbia
Ashley Mollison, Institute on Aging & Lifelong Health, University of Victoria
Shannon Turner, Executive Director, Public Health Association of BC
Heather Ouellette,Co-Chair, Policy Research and Advocacy committee, Public Health Association of BC
Stephen Portman, Together Against Poverty Society
Donald MacPherson,Director, Canadian Drug Policy Coalition, Centre for Applied Research in Mental Health and Addictions, Simon Fraser University
Jordan Westfall, President, Canadian Association of People who use Drugs
Sana Shahram, Canadian Institute for Substance Use Research, University of Victoria
Dakota Inglis, Canadian Institute for Substance Use Research, University of Victoria
Karena Shaw, Law, University of Victoria
Gerrit Clements, Law, University of Victoria.
Karen Urbanoski, Public Health and Social Policy, University of Victoria.
Meaghan Brown, Nursing, University of Victoria
Ryan McNeil, Medicine, University of British Columbia and BC Centre on Substance Use
Sally Thorne, Nursing, University of British Columbia
Jade Boyd, Medicine, University of BC and BC Centre on Substance Use
Adrienne Montani, Provincial Coordinator, First Call: BC Child and Youth Advocacy Coalition.
Alissa Greer, University of British Columbia and Canadian Institute for Substance Use Research
Budd Hall, Community Development, University of Victoria
Sally A. Kimpson, Centre for Research on Work disability Policy, Simon Fraser University
Piotr Burek, Chair of the Vancouver Island Persons Living with HIV/AIDS Society
Astrid Brousselle, Public Administration, University of Victoria
Rod Knight, Medicine, University of British Columbia, and BC Centre on Substance Use
Eric Roth, Anthropology, University of Victoria
Debra Sheets, Nursing, University of Victoria
Damien Contandriopoulos, Nursing, University of Victoria
Karen Evers Fahey, Nursing, University of Victoria
Marjorie MacDonald, Nursing, University of Victoria
Sonya Jakubec, Nursing, Mount Royal University
Kelli Stajduhar, Nursing, University of Victoria
Trudy Norman, Canadian Institute for Substance Use Research
Jan Storch, Nursing, University of Victoria
Lynn Young, Nursing, University of Victoria
Vera Caine, Nursing, University of Alberta
Margo Matwychuk, Anthropology and Social Justice Studies, University of Victoria
Flora Pagan, Social Work, University of Victoria
Bruce Wallace, Social Work, University of Victoria
Nathan Lachowsky, Public health and Social Policy, University of Victoria
Lynn Marks, History, University of Victoria
Franco Carnevale, Nursing, McGill
Shane Calder, Coordinator, Clinical Education
Kate Vallance, Canadian Institute for Substance Use Research
John Millar, Population and Public Health, UBC
Amber Prince, Atira Women’s Resource Society
James Rowe, Environmental Studies, University of Victoria
Anna Cooper, Staff Lawyer, Pivot Legal Society
DJ Larkin, Interim Co-Executive Director, Pivot Legal Society
Kendra Milne, Social justice lawyer, Vancouver BC
Sarah Wilson, Vancouver Island Persons Living with HIV/AIDS Society
Erin E. Donald, Nursing, University of Victoria
Jean Daniel Jacob, Nursing, University of Ottawa
F Beryl Pilkington, Global Health York University
Deborah Curran, Law and School of Environmental Studies, Environmental Law Centre, University of Victoria
Natalie Drolet, Staff Lawyer/Executive Director, Migrant Workers Centre
Josephine Etowa, Chair Public Health Nursing University of Ottawa
Elizabeth McGibbon, Nursing, St. Francis Xavier University
Meenakshi Mannoe, University of British Columbia
Heather Hobbs, AIDS Vancouver Island
Kim Daly, Nursing, University of Victoria
Simon Carroll, Sociology, University of Victoria
Dan Reist, Assistant Director, Knowledge Exchange, Canadian Institute for Substance Use Research, University of Victoria
Karen MacKinnon, Nursing, University Of Victoria
Carren Dujela, Institute on Aging & Lifelong Health, University of Victoria
Kim Speers, Public Administration, University of Victoria
Amélie Perron,Nursing, University of Ottawa
Gillian Kolla, Public Health, University of Toronto
Michelle Lalonde, Nursing, University of Ottawa
Adrian Guta, Social Work, University of Windsor
Stuart J. Murray, Canada Research Chair in Rhetoric and Ethics, Carleton University
Marie-Eve Sylvestre, Civil Law Section, University of Ottawa
Sarah Flicker, Environmental Studies, York University
Geoff Bardwell, Medicine, University of British Columbia and BC Centre on Substance Use
Vicky Bungay, Canada Research Chair, Nursing, University of British Columbia
Alexandra Collins, Health Sciences, Simon Fraser University, BC Centre on Substance Use
Dave Holmes, Nursing, University of Ottawa
Cheryl van Daalen-Smith, Nursing, York University
Naomi Moses, Lawyer, Rosenberg Kosakoski LLB
Lindsay Victoria Shaw, Canadian Institute of Substance Use Research
David K Wright, Nursing Professor, University of Ottawa
Kiffer G. Card, Public Health & Social Policy, University of Victoria
Leonora Marcellus, NursingUniversity of Victoria
Justin Sorge, Canadian Institute for Substance Use Research
Timothy Richards, Law, University of Victoria
Clea F. Parfitt", Lawyer
Jessica Hannon, Executive Director, Megaphone
Kendra Milne, “Canadian Mental Health Association – BC Division”
Karyn Fulcher, School of Public Health & Social Policy, University of Victoria
Ben Isitt, Victoria City Councillor and Capital Regional District Director."
Tom Sandborn, Vancouver, journalist
Erin Pritchard, Lawyer, Vancouver.
Amy Lubik, Public Health Association of BC
Kelsey Evan Rounds, Nursing, University of Victoria
Sarah Sheridan, Research Associate, BC Centre for Substance Use
Caitlin Hickman, Public Health and Social Policy, University of Victoria
Board of Directors, Lake Country Health Planning Society
Jason Nickerson, Clinical Investigator, Bruyère Research Institute
Nick Falvo, Research Associate, Carleton University Centre for Community Innovation
Helene Demers, Honourary Research Associate, Anthropology, Vancouver Island University
1. United Nations, International Covenant on Economic, Social and Cultural Rights. 1966. https://treaties.un.org/pages/viewdetails.aspx…
2. United Nations, International Covenant on Civil and Political Rights. 1966, https://treaties.un.org/Pages/ViewDetails.aspx…
3. World Health Organization, The Ottawa Charter for Health Promotion. 1986, Canadian Public Health Association and World Health Organization: Ottawa. http://www.who.int/healthpromoti…/conferences/previous/…/en/
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