Hundreds of thousands of Canadians who are just one step away from being homeless are dealing with the same devastating health risks as people living on the streets, according to new research.
Mental illness, hunger and chronic health issues such as arthritis and hepatitis are just as prevalent among the "vulnerably housed" as among the homeless, research by a network of academics, doctors and community workers suggests.
Their investigation in Vancouver, Toronto and Ottawa suggests that for every person sleeping on the street, there are 23 more who are at risk of becoming homeless - living in unaffordable, crowded and unsafe conditions.
That's approximately 400,000 people across Canada - a "hidden emergency" that is being ignored, researchers say.
The Research Alliance for Canadian Homelessness, Housing and Health says the best way to confront the problem is to improve the quality of affordable housing. Ottawa, they say, needs to set standards and develop a national housing strategy.
"We all recognize that health care is important for good health, and so we have universal health care. Decent and affordable housing is just as essential for good health," said Dr. Stephen Hwang of St. Michael's Hospital in Toronto.
It's the third high-profile call for a national housing strategy this week alone.
Earlier, Food Banks Canada said use of food banks has spiked in the past two years, and federal leadership in access to decent housing is a prerequisite to dealing with the poverty that drives hunger.
Then, an all-party Commons committee report on poverty also called on the federal government to maintain funding for the affordable housing stock, figure out ways to encourage more building, and develop a long-term plan.
"The committee believes that all Canadians have a right to adequate shelter and that a comprehensive long-term national housing strategy is essential to making this a reality," the committee report says.
But such appeals have gained little traction in the federal cabinet, despite being backed by opposition parties.
"Housing is provincial jurisdiction," Ryan Sparrow, spokesman for Human Resources Minister Diane Finley, said by e-mail on Friday.
"Housing issues differ across [the]country, and provincial governments and municipal governments are best able to identify and implement effective solutions.
"Vulnerable Canadians don't need more bureaucracy and talk."
The researchers' report on the so-called "vulnerably housed" found that the problems associated with homelessness are underestimated in Canada because many of those with roofs over their heads for now live in such precarious conditions that they could become homeless at any point.
"There's some blurring between being homeless and being vulnerably housed," Dr. Hwang said in an interview.
The people identified as vulnerable had spent almost as much time being homeless in the previous two years as the homeless group had, the study shows.
Half of them have a history of mental illness, and almost two-thirds have had a traumatic brain injury at some point.
Many of them are dealing with harsh physical-health issues too, such as arthritis, Hepatitis B, asthma and high blood pressure.
A third of them say they're having trouble finding enough to eat.
"Before now, researchers and decision-makers have often thought of these groups, the homeless and the vulnerably housed, as two distinct populations, with two different levels of need," said Dr. Hwang.
"This study paints a different picture."
The study is tracking 1,200 homeless and precariously housed people in the three cities over a two-year period. Researchers plan to follow them in the coming year to see how their housing and health status have changed.
So far, they've concluded that the biggest gulf in health outcomes is not between the homeless and the housed. Rather, it's between those who have adequate housing and those who don't.
Their lifespans are about seven to 10 years shorter than the general Canadian population, the study points out, citing previous research done in 2009.
Men in vulnerable housing situations have the same chance of living to age 75 as an average man in 1921 - before antibiotics were around. They're more than twice as likely as the average Canadian to commit suicide.
Women in similar situations are as likely to survive to the age of 75 as an average woman living in Guatemala. They're six times more likely to commit suicide than the average Canadian.
The research network includes St. Michael's Hospital, Carleton University, the University of Ottawa, the University of British Columbia and several community-services organizations and mental-health groups. The study was funded by the Canadian Institutes of Health Research.