Women, Housing, and Health

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Introduction

Housing is an increasingly serious health issue for women. With escalating poverty in Canada and throughout the world, there are growing numbers of women who are, if not homeless, then “vulnerably” or “precariously” housed*.  And recent research shows that similar health issues afflict women whether they are homeless or vulnerably housed. 

Because they tend to have higher levels of poverty, the women most affected by housing issues are Aboriginal, people of colour, immigrants or refugees, disabled, senior or youth.

The health problems that result from lack of stable housing are many and severe. Poor housing places women at higher risk for chronic and infectious diseases and premature death. They are often homeless because of a history of physical, sexual, or emotional abuse. When pregnant, they aren’t likely to get prenatal care or family planning advice or services. Many suffer from mental health problems and substance abuse disorders. They are three times more likely than men in the same housing conditions to commit suicide, and six times more than women with adequate housing. Homeless women are at extreme risk of being targets of sexual assault and other forms of violence. At the same time, they suffer more from HIV/AIDS and other sexually transmitted infections, as well as a host of other gynaecological problems.

Finally, while all homeless people face considerable barriers to accessing health care, women face additional obstacles. This is because many services to the homeless have been developed for men, and are inappropriate for homeless women and their children.

* “Vulnerably-housed”, “precariously-housed” and “marginally-housed” are all terms that refer to people whose housing is not secure. It can refer to people who have housing now but who have lived on the street or moved at least twice in the past year. They may also spend at least 50% of their income on poor, crowded and/or unsafe housing.

Why is housing such a serious health issue for women?

Whether homeless or living in unstable housing, women are at high risk of a multitude of severe health problems. From suffering violence and substance abuse, to mental illness, respiratory ailments, diabetes, STI’s and HIV, hypertension, dental problems and more – the list of health risks is long and culminates in premature death. The following resources draw the links between inadequate housing and poor health, looking specifically at women.

Winnipeg Street Health Report 2011
By Suzanne Gessler and Christina Maes, Main Street Project, 2011
Presents the results of a 2010 survey on the physical and mental health status of 300 homeless people in Winnipeg. Found that women have quite different health care needs than men. For example, 15% had given birth while homeless, almost half of the women were victims of sexual assault, and 25% of the women had not had a Pap test in three years.

Precarious Housing in Canada
Wellesley Institute, 2010

Research and policy report with a gender analysis that sets out a pragmatic, five-point plan for improving the health of the millions of Canadians who are living in substandard, over-crowded and unaffordable homes – plus those who are living without any housing at all.

Housing and Health: A Sex‑ and Gender-based Analysis from Manitoba
By Margaret Haworth‑Brockman and Lissa Donner, in
Rising to the Challenge: Sex‑ and gender‑based analysis for health planning, policy and research in Canada, pp. 110-114, Atlantic Centre of Excellence for Women’s Health, 2009
Examines why women are more likely than men to live in unsuitable, inadequate or unaffordable housing in Manitoba. Includes the commentary Women, Gender and Potable Water on the lack of access to clean drinking water, a major health issue in northern and Aboriginal communities.

Worth a Second Look: Considerations for Action on Health Inequities in British Columbia with a Sex, Gender, and Diversity Lens
British Columbia Centre of Excellence for Women’s Health, 2009

A sex- and gender-based analysis of two sets of health indicators in BC: cardiovascular and respiratory disease, and diabetes, and their relationship to women’s life expectancy; and poverty, food insecurity and homelessness.

Taking a Second Look: Analyzing Health Inequities in British Columbia with a Sex, Gender, and Diversity Lens
British Columbia Centre of Excellence for Women’s Health, 2009

Suggests responses and actions that can be taken as a result of the sex and gender based analysis of Worth a Second Look: Considerations for Action on Health Inequities in British Columbia with a Sex, Gender, and Diversity Lens.

Women and Homelessness
The Street Health Report 2007

Carried out in partnership with Sistering, this report documents the brutal impact of homelessness on women’s health in Toronto, calls homelessness a “life-threatening” condition for women, reveals staggering rates of sexual assault among homeless women, and documents health effects that significantly reduce their life expectancy.

Women Need Safe, Stable, Affordable Housing: A study of social housing, private rental housing and co-op housing in Winnipeg
By Molly McCracken and Gail Watson, Prairie Women’s Health Centre of Excellence, 2004

Documents the effects of different housing policies on Winnipeg women's health and well being, economic security, and skills. 

Common Occurrence: The Impact of Homelessness on Women’s Health
Sistering, 2002

This earlier report by Sistering first highlighted women and homelessness (visible and hidden) in Toronto, demonstrating that homelessness is a women's health issue, and recommending how the health care system can improve its responsiveness and effectiveness in supporting women.

Health Status of Homeless Women: An Inventory of Issues
Ontario Women’s Health Council, 2002

Provides an inventory of health-related issues facing homeless women in Toronto. Explores the obstacles these women encounter in accessing acute, preventative, and other kinds of health care.

A Primary Care Approach to Treating Women without Homes: Medical Illnesses of Homeless Women
By Roseanna H. Means, MD, MSc, Medscape Today, 2001

Describes numerous types of chronic conditions that homeless women are likely to suffer.

What health problems are women – homeless and vulnerably housed – suffering from?

The illnesses that afflict women without stable housing are too numerous to list here. Those we have mentioned are among the most prevalent. These illnesses are also highly interrelated. Homeless women have the highest rate of mental illness in our society, and the most common are clinical depression, post-traumatic stress disorder, and substance use disorders. Women without stable housing are also more prone to substance abuse and addictions, and sexually transmitted diseases. And finally, women die younger when they are homeless. One study in Toronto found that homeless women 18 to 44 years old are 10 times more likely to die than women of the same age group in the general population.

Mental Health

Rural and Remote Women and The Kirby-Keon Report On Mental Health: A Preliminary Gender-Place Analysis
Prairie Women’s Health Centre of Excellence, 2007

Examines the housing needs and issues for women with mental health issues, in both rural and urban areas of Canada.

Supportive Housing Needs of Women with Mental Health Issues
Social Policy Research Unit (University of Regina)
and the Regina YWCA, 2000
Examines the supportive housing needs of women with mental health issues who do not easily fit into many of the existing programs.

Substance Abuse and Addictions

Women-Centred Harm Reduction
British Columbia Centre of Excellence for Women’s Health, 2009

A guide to bringing a gender-based analysis to harm reduction strategies for substance use. Introduces some of the intersecting components of harm reduction and health determinants, including housing. One of a series on Gendering the National Framework for Action to Reduce the Harms Associated with Alcohol and other Drugs and Substances in Canada.

Poly-Substance Use among Male and Female Street Youth in Toronto, Canada
By Maritt J. Kirst, Patricia Erickson and Carol Strike,
International Journal of Social Inquiry, Volume 2, Number 2, 2009, pp. 123-139
Examines how health and social factors may have different impacts on street youths’ drug use patterns according to gender.

Homelessness, Housing, and Harm Reduction: Stable Housing for Homeless People with Substance Use Issues
By Deborah Kraus, Luba Serge and Michael Goldberg of the Social Planning and Research Council of British Columbia, Canada Mortgage and Housing Corporation, 2005

An investigation of innovative housing programs in Canada and throughout the world that best help women and men who are homeless or at risk of homelessness and who have issues associated with substance use.

HIV/AIDS and other sexually transmitted infections

HIV, Housing & Women’s Health
From “Under My Umbrella”: The housing experiences of HIV positive parents who live with and care for their children in Ontario, Positive Spaces, Healthy Places, 2010
Describes a study finding that among people with HIV, women are twice as likely as men to be homeless.

Sexually Transmitted Infections in Canadian Street Youth
Public Health Agency of Canada, 2006

Findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003, including an analysis of gender differences.

Early Death

Risk of Death among Homeless Women: A Cohort Study and Review of the Literature
By Angela Cheung and Stephen Hwang, CMAJ, Volume 170, Number 8, April 13, 2004, pp. 1243-1247

Research study finding the common causes of high death rate among homeless women to be AIDS, drugs, and suicide.

Homeless women 'crisis' -- In Toronto, they're dying at 10 times the normal rate
By Elaine Carey, The Toronto Star, April 13, 2004

Article describing the study above. (Scroll down the page for this and other articles on this topic.)

What does violence toward women have to do with it?

As all the resources below show, violence against women is deeply interconnected with women’s homelessness or unstable housing. Women flee their homes to escape violence, only to encounter it again on the streets. Women on the street may turn to prostitution to survive, where they are a high risk of assault. They may “couch surf” – sleep with different men night after night – risking their lives for a bed to sleep in. The cycle of violence and victimization is unrelenting for many homeless women.

Shedding Light on the Barriers to Housing: A Photovoice Exploration
By Natasha Jategaonkar and Pamela Ponic, BC Non-Profit Housing Association, University of British Columbia & BC Centre of Excellence for Women’s Health, 2010
A community-based Photovoice project that explored the systemic barriers to housing for women leaving violent relationships. The project involved 45 women in four British Columbia communities. To request a hard copy of this report (it is not available online), please email the BC Non-Profit Housing Association at admin@bcnpha.ca

Violence against Women & Women’s Homelessness: Making the Connections
YWCA, 2010

Discusses the need for a national housing strategy, by drawing the connections between violence against women and homelessness, noting housing needs particularly among Aboriginal women, women in the north, and women with disabilities.

Beyond Shelter Walls - No More Running in Circles: Discussion Paper
By Amanda Dale, YWCA, 2008

Explores links between intimate partner violence, lack of supports leaving shelter and homelessness among women and children.

Victimization and Special Challenges of Women Living on or Near the Streets of Toronto
Ontario Women’s Justice Network, 2008

Describes how most women living on or near the streets have been victims of domestic, physical or sexual abuse at home, only to experience more victimization when they seek refuge at shelters or on the streets.

No Safe Place: Sexual Assault in the Lives of Homeless Women
By Lisa Goodman, National Online Resource Center on Violence against Women, 2006
Describes the cycle of sexual violence that homeless women are caught in, and recommends how to respond to homeless women’s needs and to break this cycle of violence.

Which women are particularly at risk for unstable housing or homelessness?

Some groups of women are more likely to experience homelessness or unstable housing conditions than others. Poor women are, of course, at the highest risk, and this group includes those who are most marginalized in our country: Aboriginal women, younger women, immigrant women and transgender people.

Homesick: Gender, Youth and Homelessness in Toronto - The Health Experiences of Young Women in Exceptional Circumstances
By Vanessa Oliver, OWHN E-Bulletin, Winter 2009

Examines the health and health-seeking behaviours of homeless young women aged 15-24 in Toronto.

“A Story I Never Heard Before”: Aboriginal Young Women, Homelessness, and Restoring Connections
Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health
, Volume 6, Number 3, Winter 2008, pp. 31-54
Explores the stories of the nine homeless Aboriginal girls, placing their stories in context of colonialism in Canada and the destructive legacy of residential schools.

The Arctic: Gender Issues
By Clara Morgan
, Social Affairs Division, Library of Parliament, 2008
Describes the high rate of domestic violence in Canada’s Arctic that places women at high risk of homelessness in a region where housing shortages are especially severe.

Being Homeless Is Getting to Be Normal: A Study of Women's Homelessness in the Northwest Territories
YWCA Yellowknife and the Yellowknife Women’s Society, 2007

Reports on the conditions in the Northwest Territories that underlie women’s homelessness.

Immigrant Women, Family Violence, and Pathways Out of Homelessness
By Wilfreda E. Thurston et al., National Secretariat on Homelessness, 2006

Investigates the connections between family violence, immigration and women’s homelessness, and proposes preventative solutions.

Crossing to Safety: Transgender Health and Homelessness
Healing Hands
, HCH Clinicians Network, Volume 6, No. 4, June 2002, pp. 1-2
Discusses the issues facing homeless transgender people who often end up on the street as a direct result of job or housing discrimination, with fewer legal protections than other sexual minorities have.

What barriers to health care services do homeless women face?

Women with no home face a huge number of barriers to accessing quality health care. They likely have no regular health care provider. With no phone or address, they have a hard time scheduling appointments and getting notified of test results and referrals to follow-up care they may need. They often rely solely on emergency services to see a doctor, which means they have no continuity of care.

Reaching Out to the Homeless and Pregnant
By Megan Ogilvie, Toronto Star, March 13, 2010

Describes the work of nurses with the Homeless At-Risk Prenatal Program, or HARP, in Toronto.

Homeless and Pregnant, Women Afraid to Seek Care
The Edmonton Journal
, November 12, 2008
Discusses the prenatal and other health care issues facing homeless women in Edmonton, and the reasons that homeless women do not seek needed care. 

Health Care for Homeless Women: Unmet Needs and Barriers to Care
By Joy Lewis, Ronald Andersen and Lillian Gelberg, Medscape Today, 2003

Shows that there is a significant unmet need for medical care among homeless women, homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times.

Making a Home for Homeless Women
By Zoe Gollogly, Medscape Today, 2001

Article describing the founding of Women of Means, a Boston clinic created in 1999 “to improve the lives of women who are homeless or marginally housed through quality health care, education and advocacy.”

How do housing policies affect women’s health?

A key factor to improving health conditions caused by poor housing is to first understand the connections between government policies and housing. Also vital is to see how this is related to the unequal position of women, both economically and socially. These resources look at how current government policies impact women’s housing, and recommend the changes that would improve women’s lives.

Prosperity for the Majority: Toward Economic Security for Women
YWCA, 2010

Pre-Budget Submission to the House Standing Committee on Finance calling for a National Housing Strategy with a gender lens, funding for women’s housing in Northern Canada, funding for programs serving homeless women, coordinated policies for violence against women, and increased federal transfer payments for legal aid.

Trans-Canada Homelessness Highway: A Women's Route Map
Women’s Housing Equality Network, 2008

Map of Canada that provides detailed information about the “routes” to women's homelessness, including federal, provincial and territorial policies that contribute to homelessness, and the policy changes that are needed to ensure women have access to housing that is adequate, affordable, safe and secure.

Women and Housing in Canada: Barriers to Equality
Centre for Equality Rights in Accommodation, 2002

Discusses how federal government programs and policies create barriers to women’s equality, resulting in more poverty and unstable housing among women.

Left in the Cold: Women, Health and the Demise of Social Housing Policies
Prairie Women’s Health Centre of Excellence, 2001

Describes federal and provincial housing policies and their effect on women's health as well as women’s experiences living in or having lived in sub-standard housing.

Matrimonial Real Property - Overview
Native Women’s Association of Canada

Discusses how the lack of clarity in matrimonial property laws on reserves means that women in common law relationships who are experiencing violence, or who have become widowed, may lose their homes.

Where can women find housing supports?

These resources point to some of the positive work going on across the country to help women find and live in healthy housing.

Herstreet
By Jane Shulman, Network
, Fall/Winter 2010/11 Volume 13, Number 1
Describes the Montreal organization Herstreet, which serves the needs of women who are homeless or at risk of becoming homeless.

 “I Built My House of Hope:” Best Practices to Safely House Abused and Homeless Women
By Leslie Tutty et al., Resolve, 2009

Recommends best practices to safely house abused and homeless women, based on reviews of current practices and interviews with women from across Canada who had been abused by partners and homeless at some point in their lives.

Coming Together: Homeless Women, Housing and Social Support
By Izumi Sakamoto, Josie Ricciardi, Jen Plyler, and Natalie Wood, The Wellesley Institute, 2007

An arts-based community research project exploring how women and transwomen who are marginally housed build support networks with each other in order to survive.

Domestic Violence Relief Fund
The Community Housing Land Trust Foundation

Manual for housing co-ops in BC to learn how they can welcome women who are victims of violence into their co-ops.

Atira Women’s Resource Society
Vancouver organization committed to the work of ending violence against women through providing direct service, as well as working to increase awareness of and education around the scope and impact on our communities of men's violence against women and children.

Portland Hotel Society
Housing project in Vancouver for homeless women and men. 

Aboriginal Women’s Guide to Housing & Shelters in Winnipeg
Mother of Red Nations Women’s Council of Manitoba, 2007

Practical guide for women seeking housing resources in Winnipeg.

YWCA Canada
Shelter, housing & support services for women in Canada