Investing in Affordable Housing: Upstream policies to help promote health and wellbeing Submission from the Association of Ontario Health Centres to consultations on the Long-Term Affordable Housing Strategy update July 2015

Contact:

Jacquie Maund Policy and Government Relations Lead, Association of Ontario Health Centres (AOHC) Tel: 416.236.2539 x 234 [email protected]

Affordable, Secure, and Safe Housing: A social determinant of health The Association of Ontario Health Centres (AOHC) is the voice of community-governed primary health care in Ontario. AOHC’s vision is the best possible health and wellbeing for everyone living in Ontario. We know that secure, affordable housing is strongly tied to people’s physical and mental health, and is the foundation for strong and healthy communities. Low income people in unstable housing are at risk for poor health and becoming high users of the healthcare system. Access to safe, affordable housing is one of the determinants of health, so it is timely for the province to update Ontario’s Long-Term Affordable Housing Strategy. AOHC members include 109 Community Health Centres (CHCs), Aboriginal Health Access Centres (AHACs), Community Family Health Teams (CFHTs), and Nurse Practitioner-led Clinics (NPLCs) across the province. CHCs and AHACs have a mandate to serve people with barriers accessing health services, including low income people, Aboriginal People, people with disabilities, newcomers and refugees, people who are LGBT, Francophones and people in rural or remote communities. Under one roof, CHCs and AHACs provide both primary health care services and a wide range of health promotion and community development services that help address the determinants of health. Examples include: Pathways to Education, pre and post-natal nutrition programs, community gardens and community kitchens, and programs that support improved employment and housing. About 54% of people served by CHCs are low income – many are dealing with the challenges of finding and keeping safe, affordable housing in Ontario. Many of the people we serve are living in the poorest neighbourhoods which have the poorest quality housing and the poorest health profiles. About 6% of the people seen at CHCs have serious mental health issues and many are homeless. So health service providers in CHCs see firsthand the impact that the lack of safe, secure, affordable housing has on the physical health, mental health and overall wellbeing of the people we serve. But as health service providers we can only go so far in addressing the determinants of health – we need upstream interventions with public policies that ensure livable incomes, affordable housing, as well as good jobs and working conditions. So AOHC is pleased to provide input to updating the Long-Term Affordable Housing Strategy with the goals of achieving better housing outcomes for more people, creating more affordable housing opportunities, and ending/preventing homelessness. An effective housing strategy also supports the government’s stated goal of building a culture of health and wellness in Ontario. We note the Consultation Discussion Guide acknowledges the key problem that the demand for social and affordable housing exceeds supply in Ontario. We are pleased that your paper notes equity issues with some groups being at much higher risk for housing insecurity. In particular Investing in Affordable Housing| 1

Aboriginal People are more likely to be in core housing need than non-Aboriginal Ontarians. We support the observation that tailored approaches are required to meet the housing and support needs for vulnerable groups including: women fleeing violence, people with mental health and addictions challenges, people with disabilities, seniors and youth. Our work has taught us that governments need to move to an upstream approach and make strategic policy decisions that will improve health and wellbeing today to prevent spending on sickness care in the future. Effective public policies and programs that tackle housing insecurity and homelessness represent an example of an upstream approach to address the social determinants of health. These measures will require new funding and investment by the Province. AOHC urges the Ontario government to ensure there is sufficient public revenue to invest in affordable housing by pursuing new revenue raising measures within the context of a progressive tax system. Lack of affordable housing impacts health  There is a lack of affordable, safe housing in Ontario with over 165,000 households on the waiting lists for rent-geared-to-income housing with wait times of up to ten years. [1]  1 in 5 Ontario tenant households spend 50% of their income on rent. Paying anything over 50% puts people at a high risk of homelessness. Food bank clients on average spend 71% of their income on housing, leaving little left for nutritious food and other living costs. [2]  New research finds that people who are most at risk of becoming high users of the healthcare system are those who are food insecure, low income, and in unstable housing. [3]  The first Ontario report using research for the Canadian Index of Wellbeing found that living standards had not improved between 1994 and 2010, and housing affordability had increased by just 1.2 per cent. [4]

Responses to consultation questions

Our input below addresses selected questions from the list posed in the Consultation Guide. How can we better support the non-profit sector (including co-ops, private, and municipal non-profits) in maintaining, replacing, and expanding social and affordable housing?  As recommended by the Co-operative Housing Federation of Canada, Ontario should advocate to the Federal Government to preserve federal funding that provides rent supplements for over 100,000 Ontario households living in co-op and non-profit Investing in Affordable Housing| 2

housing. Most of this funding will expire in five years. Work with the Federal government by cost-sharing a new rent supplement program to support these households so their housing is not placed at risk.  The Province must work with municipalities to provide capital repair grants to ensure social housing stock is in good condition. More than more than 267,000 Ontario households depend on social housing that is over 40 years old. How can we improve regulatory and legislative tools to enhance housing affordability?  Amend the Provincial Planning Act to give municipalities the ability to establish inclusionary zoning bylaws that are not subject to Ontario Municipal Board challenges. This would allow municipalities to leverage private sector development and require developers to set aside a number of units in each new residential project as affordable housing.  The Private Member’s Bill 39, the Planning Statute Amendment Act, seeks to do this and should be passed into law.  Make no-cost reforms to the Residential Tenancies Act to better protect tenants’ rights to affordable, well-maintained homes, as recommended by the Advocacy Centre for Tenants Ontario. What steps should the federal government take to support housing supply, including social housing?  The federal government should develop a long-term Canadian housing strategy. This strategy must provide adequate funding and time-bound goals related to reducing homelessness, reducing unmanageable mortgage debt, and securing adequate stocks of social housing and affordable rental housing across Canada. How can we improve access to housing assistance and reduce wait times?  The Province should provide a monthly Housing Benefit to low income renters to help them cover the high cost of rent and reduce dependence on food banks.  The Daily Bread Food bank along with front-line and private sector agencies have developed a proposal for an Ontario Housing Benefit. [5] The average benefit would be $103 per month. The size of the housing benefit would vary depending upon household size, level of income, and the size of rent compared to household income.  A number of Community Health Centres are co-located with affordable housing units or provide support services to help people find housing. For example, West Elgin CHC in West Lorne provides assisted living services to seniors and adults with disabilities in adjacent rent-geared-to-income buildings. Somerset West CHC in Ottawa provides services to homeless families in a nearby shelter. This approach should be encouraged Investing in Affordable Housing| 3

and supported by the province as CHCs are already working with low income clients and can help link people in need with affordable housing. It reflects the effectiveness of Community Hubs where a broad range of partners and services operate under one roof to provide a full range of services including health, education, social supports and recreation. How can we better support people who are homeless to become stably housed?  Many people who are homeless are dealing with mental health and addictions challenges. Decades of international research has demonstrated that recovery from mental illness and addictions cannot happen if people do not have adequate housing. Housing with supports is critical to recovery, but one model does not fit all.  AOHC supports the recommendations of Addictions and Mental Health Ontario and the Toronto Supportive Housing Network which call for a three prong plan for provincial investment in supportive housing: •

Increase the availability of high support housing to ensure smoother transition for people back into the community and better health and wellbeing for people recovering from mental health and addictions issues;

•

Fund a bank of rent supplements in communities across Ontario to help people moving from supportive housing to find independent housing they can afford;

•

Invest to build new affordable supportive housing units for people with mental health and addictions issues.

 This plan calls for at least 3,500 new units of supportive and supported housing to be built annually across Ontario over the next six years with a cost of approximately $100 million per year. [6] ______________________________________________________________ Notes: [1] Ontario Non Profit Housing Association (2014). Waiting lists survey 2014. [2] See more at: http://www.dailybread.ca/learning-centre/housingbenefit/#sthash.K6DgEplr.dpuf [3] Tiffany Fitzpatrick, MPH, Laura C. Rosella, PhD, MHSc, Andrew Calzavara, MSc, Jeremy Petch, PhD, MA, Andrew D. Pinto, MD, MSc, Heather Manson, MD, MHSc, Vivek Goel, MD, MSc, Walter P. Wodchis, PhD, MAE, MA (2015). “Looking Beyond Income and EducationSocioeconomic Status Gradients Among Future High-Cost Users of Health Care”. American Journal of Preventative Medicine, May 2015 http://www.ajpmonline.org/article/S0749-3797(15)00082-3/pdf

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[4] Faculty of Applied Health Sciences, University of Waterloo. How Are Ontarians Really Doing? (2014) https://uwaterloo.ca/canadian-index-wellbeing/ [5] http://www.dailybread.ca/learning-centre/housing-benefit/ [6] http://www.addictionsandmentalhealthontario.ca/uploads/1/8/6/3/18638346/supportive_hou sing_proposal_from_amh_ontario_final.pdf *********************

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