Thinking Outside the Crisis: Housing as Healthcare in the North

Housing is more than a matter of shelter—housing is healthcare. It’s time for a northern housing strategy that recognizes this critical connection.

This article is part of the Independent’s ongoing series, Thinking Outside the Crisis. Read Robin Whitaker’s introduction here.

Chronic housing need has plagued many northern Canadian communities since the introduction of state-sanctioned housing programs following the Second World War. It has reached a state of crisis in recent decades.

The problem is not just a shortage of stock. From the beginning, northern housing failed to reflect the cultural needs or contextual realities of communities, with housing built by-and-large for nuclear families and southern climates. Inconsistent policy and administration, along with the ideologies framing housing provision, all exacerbated culturally and contextually inappropriate northern housing.

In 2004, the federal government began a protracted clawback of annual funds for social housing in the North, with the intent to reduce these funds to zero by 2037. In fact, the “northern housing crisis” as a concept gained traction alongside this withdrawal of federal funds—it exposed the precarity of northern housing and further deepened the urgency felt by northern communities and leadership. Previously consistent funding has been replaced with sporadic packages that leave northern communities and governments scrambling for opportunities on a piecemeal basis. Additionally, the bulk of funding goes toward maintenance and retrofitting of existing units, not to building the new housing units so badly needed across the Canadian North.

But housing is more than a matter of shelter. The northern housing crisis—combined with widespread inequities in access to health care—intensify the risks of COVID-19 in northern communities. Indigenous leaders and chief medical officers across the North have warned that a prevalence of compounding factors, including high rates of diabetes as well as asthma, tuberculosis and other respiratory illnesses, will likely make the impact of the virus especially harsh in northern communities. For example, Inuit Nunangat as a whole has a tuberculosis rate that is roughly 300 times that of non-Indigenous Canadians, and Inuit children experience the highest rates of chronic respiratory disease in the world. Both are linked directly to housing need. There is no time more critical to underline these connections than in the face of a pandemic. Housing is health care.

Perpetual Crisis

Dictionary definitions suggest that crisis is exceptional, a situation marked by instability and impending decisive change, a breaking point that requires an urgent response without which there will be collapse. And yet, northern housing has been at a critical tipping point for decades. What purpose does it serve to think of chronic northern housing need as a crisis, particularly when the breaking point becomes routine, and governments fail to respond with the urgency required?

Rates of core housing need—a national measure of housing affordability, suitability and adequacy—have not only persisted across the North: they are rising. In Nunavut,37 percent of the territory’s residents live in core housing need, the consequences of which extend well beyond housing. Alongside individual and community health, access to affordable, suitable, and adequate housing is critical to promoting successful education and employment outcomes.

In 2019, the Inuit Nunangat Housing Strategy underlined that “over half (51.7%) of Inuit in Inuit Nunangat live in crowded housing compared to 8.5% percent of non-Indigenous Canadians.” Rates of overcrowding in Inuit communities are high. While this willingness to share space testifies to the level of care Inuit have for one another, it also means that Inuit families bear the brunt of chronic housing need in their communities. In Nunavut and Nunavik, over half the population live in overcrowded homes. Meanwhile, in Nunatsiavut, almost a third of the population live in overcrowded housing, three-quarters of homes are in need of repairs, and there are long waiting lists to get into housing.

The interconnection between housing need and health is all too clear in Labrador. In 2018, a tuberculosis outbreak hit Nain, a Nunatsiavut community of 1,200 where nearly 50 families are on a wait list for housing. The outbreak killed a 14-year-old boy and forced another 50 people into treatment. It also exposed a persistent housing crisis in Labrador’s remote Inuit communities. Nunatsiavut as a whole has the highest rate of tuberculosis in Canada at over 400 times the non-Indigenous rate—248 cases for every 100,000 people versus 0.6 cases for every 100,000 amongst non-Indigenous Canadians. The 2018 outbreak brought new health care resources to Nain, including TB clinics, an X-Ray machine and disease specialists. But without fixing the housing crisis, tuberculosis will remain a stubborn problem in the region. Similarly, since housing is a social determinant of health, acute vulnerability to public health crises will persist without a northern housing strategy that recognizes these critical interconnections.

The Future is Now

In Canada, the Spanish Flu pandemic of 1918-19 had its most severe impacts on Indigenous populations. The same was true in Newfoundland and Labrador, where the Inuit communities of Okak and Hebron suffered nearly unthinkable losses. Many of the challenges that made the effects of this pandemic so devastating a century ago remain today: limited access to health facilities; food insecurity; and deeply inadequate housing are just some of the conditions that result from an ongoing legacy of colonialism.

In other words, systemic health and infrastructural inequities experienced by Indigenous peoples significantly challenge their capacity to respond to a global pandemic like COVID-19.

Such deep rooted socio-economic inequities were exposed again when Indigenous peoples were overrepresented among those affected by the H1N1 influenza that hit Canada from 2009-2010, accounting for 17.6 percent and 8.9 percent of deaths during the first and second waves respectively. Meanwhile, Indigenous people were 6.5 times more likely than non-Indigenous Canadians to require intensive care due to the virus. The disproportionate impact of this pandemic on Indigenous peoples and the hugely inadequate federal response was captured in shocking reports of Health Canada sending body bags to First Nations communities in northern Manitoba. The was region hit hard by H1N1 in part due to the patchwork health care system where community members traveling south for medical appointments were the leading source of H1N1 transmission. A swathe of harmful decisions that informed the scarce and slow supply of hand sanitizer, masks, and respirators—combined with a critical breakdown in communication and coordination between different levels of government—reflects the structural racism that persistently disadvantages Indigenous populations.

These moments underscore the importance of history for understanding the disproportionate risk of the current pandemic on northern and Indigenous communities—and the compelling need for a better framework of support so that pandemic history is not repeated. Indeed, as the National Collaborating Centre for Indigenous Health (NCCIH) recognized in 2016: “The lessons learned from the public health response to the 2009 pandemic highlight the need to ensure that public health responses in future pandemics can be efficiently and effectively implemented in Indigenous communities, but also point to the need for broader policy changes to address deeply rooted socio-economic, political and health services inequities.”

Finding ourselves in the midst of one of these ‘future pandemics,’ we must ask: have we learned many lessons? The persistence of chronic housing need in Labrador would suggest that the ‘broader policy changes’ called for by the NCCIH have fallen significantly short. For Labrador’s Inuit and Innu communities, collective memory of previous public health crises provoked quick action to prevent the spread of COVID-19. As in First Nations, Inuit and Métis communities across Canada, the Nunatsiavut, NunatuKavut and Innu governments placed heavy restrictions on travel into their communities. They also lobbied the provincial and federal governments to limit travel into the region to essential workers.

Federal Response

Perhaps the Canadian government has also taken heed of warnings from the past. Federal efforts to help northern and Indigenous communities through the COVID-19 pandemic recognize their elevated and often-contextualised vulnerability. The Indigenous Community Support Fund, announced on March 18th, constitutes a $305 million aid package for Inuit, First Nations and Métis to prepare for and react to the spread of COVID-19. Temporary shelters and isolation tents are being sent to remote communities for screening and testing, while Indigenous Services Minister Marc Miller will join the government’s COVID-19 committee as a full member, as requested by national Indigenous leaders. In addition, the federal government is providing a further $25 million to Nutrition North Canada, enabling the subsidy program to expand the range of nutritious food items accessible in isolated northern communities.

Although questions remain over whether these federal relief funds are enough—and the provision of tents to First Nations for isolation and testing leaves plenty of room for criticism— the federal government’s recognition of resilience and innovation in northern and Indigenous communities is worth noting. Funding allocated through the Indigenous Community Support Fund made its way quickly and directly into the hands of communities to spend in line with their priorities. The specific plans being made by community leaders from the Inuit government of Nunatsiavut, the Innu Nation and the NunatuKavut community council, demonstrate why such flexibility and community control of funds is necessary to meet local needs. Meanwhile, the Newfoundland and Labrador government might learn from British Columbia’s recently announced collaborative framework for healthcare. Intended to build on federal funds, the framework promises to tailor help for BC’s First Nations and Métis communities that are working to address the unique challenges they face in their pandemic response in ways that work for them.

Rethinking Crisis in the Canadian North

When the pandemic first appeared in Canada, communities in Labrador, as in the rest of the Canadian North, were deeply concerned about what the novel coronavirus could mean for public health. Strict containment strategies have been the only hope of ensuring COVID-19 does not spread widely in the region. However, containment strategies are not sustainable over the long-term, nor do they address the root causes of disproportionate vulnerability to public health crises.

What if the northern housing crisis got the critical response it merits? If the COVID-19 pandemic has shown us one thing, it is that governments and citizens can be swift, bold and resourceful in their reactions to crisis. Indigenous Peoples in Canada have long demonstrated their resilience to health crises, including past pandemics and the ongoing housing problem. The federal response to COVID-19 shows what is possible when governments understand their role as one of respecting and facilitating this resilience: making collaboration and contextualized support the core driving values, and delivering consistent funding directly to northern and Indigenous communities. This is the foundation we need to re-orient the government’s response to the northern housing crisis.

Julia Christensen is a Canada Research Chair in Northern Governance and Public Policy in the Department of Geography at Memorial University. Aimee Pugsley is a graduate student in the Research Storytelling Lab.

Photo of Natuashish via Google Maps.

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