As a specialty hospital in Toronto providing care for people living with and at risk of HIV, Casey House serves people who face multiple barriers to having their basic needs met. We acknowledge that systemic inequities have a profound effect on people’s lives, and believe that everyone deserves judgment-free care – both within and beyond our hospital. With the continuing drug poisoning crisis, housing crisis, and rising cost of living, the need to address the social factors that determine health and well-being is beyond urgent; and tackling these challenges requires thoughtful, transparent, accountable, and compassionate leadership that views people for their humanity amidst the challenges they face.
With less than a month until the mayoral by-election, we are sharing three principles that the next Mayor of Toronto must champion to improve health care and outcomes for people in high need:
1. Housing is a human right, and stable housing and safe living conditions are essential to health and well-being
It is well known that homelessness and precarious housing are at crisis points in Toronto; in fact, Toronto City Council recently declared homelessness an emergency. In addition to a lack of affordable housing options for all income levels, there is a constant lack of emergency shelter spaces to accommodate the volume of people experiencing homelessness – a population in which Black, Indigenous, and other racialized groups continue to be over-represented. Given this reality, many people are sleeping outdoors, including in homeless encampments. The absence of a safe, stable place to sleep and access to the necessities of life makes it difficult to attain stability and adhere to a daily routine, which negatively impacts people’s physical and mental health, particularly during periods of inclement weather. As one Casey House nurse expressed, “For people without housing, managing their health requires so many things they just don’t have access to.”
The city’s housing charter and action plan recognize that housing is essential to the inherent dignity and well-being of the person, however this human right to housing is far from realized. While progress has been made, and while other orders of government have a role to play, there is much more work to do. The next Mayor of Toronto must exercise their power and responsibility to uphold and fulfill the human right to housing for all Torontonians. This entails allocating the maximum available resources, and using all appropriate means, to provide equitable, low-barrier access to adequate housing; and heeding the recommendations of Toronto’s Ombudsman to ensure a fair, consistent, transparent, and accountable response to homeless encampments.
2. Substance use is a health issue, not a criminal justice issue, and people who use drugs should not be criminalized
Despite substance use being a health issue it is treated as a criminal justice issue in Canada, which creates barriers to health services, particularly for people living in deep poverty. It leads health care providers to require that people stop using drugs in order to receive care; deters people from accessing services and supports which would build their resilience and improve their well-being; and drives the inevitable market of illegal drugs which have become increasingly toxic. Moreover, the criminalization of drugs is rooted in colonialism and racism, not in science or public health, and disproportionately impacts Black and Indigenous communities.
In Toronto, promising work is underway to address this systemic barrier: Toronto Public Health’s request to Health Canada to decriminalize illicit drug possession is a decisive policy action. Allowing the possession of drugs for personal use is imperative for decreasing stigma, creating pathways to health care, and improving health outcomes. Equally critical is how this policy change is implemented: it must be supported by a wide range of health and social services that respond to the diverse needs of people who use drugs, including harm reduction – a people-centred and evidence-based approach that aims to reduce the risks of substance use without judgment or preconditions of support. The next Mayor of Toronto must continue to lead and support the critical work underway to help protect people from a toxic drug supply; reduce the harms of substance use, including stigma and discrimination; and respect the health, dignity and human rights of people who use drugs.
3. Everyone deserves to be treated with dignity, compassion, and respect amidst the challenges they face, when interacting with local government
The city’s community safety and well-being plan strives for Toronto to “Become a Trauma-Informed and Responsive City”, one that is “grounded and directed by a thorough understanding of the complete impacts of trauma, adversity, racism and violence on people, families and neighbourhoods.”
A trauma-informed approach accepts and understands the impact of trauma on someone’s life; provides an opportunity for people to express their needs and experiences without feeling judged; and cultivates safety in every interaction to build trusting relationships. In our city, this means providing supports and infrastructure that are accessible and responsive to people’s circumstances and reflect the lived experiences of people from all walks of life, so that everyone feels safe, supported, and respected. The next Mayor of Toronto must champion Toronto’s commitment to becoming a trauma-informed and responsive city by acknowledging the profound effects of systemic inequities on people’s lives; ensuring that city services are delivered to help people to achieve stability in their lives and address the barriers they face; and espouse the fundamental notion that everyone deserves judgment-free care and support.
Leading with unequivocal compassion
All levels of government have a vital role to play in addressing the social factors that determine health and well-being, and in improving health care and outcomes for people in high need. As Toronto embarks on a new chapter of municipal political leadership, thoughtfulness, transparency, accountability, and compassion are imperative to promoting the health, dignity, and human rights of all Torontonians.
Casey House recognizes and acknowledges that systemic inequities deeply affect our clients, and believes it is our responsibility to advocate for compassionate and socially-just health care. Our advocacy seeks to address the structural barriers that prevent optimal health, and improve the well-being of all people living with or at risk of HIV. To learn more, visit Advocacy.