Executive Summary

"Women are waiting for a breakthrough." – Inclusion Researcher

It is well known that adequate living conditions and social inclusion are key determinants of health.The World Health Organization (1) and Health Canada(2) have repeatedly emphasized that inadequate living conditions are primary threats to our health.They are associated with shorter life spans as well as a wide range of illnesses, including heart disease, diabetes, cancers, respiratory illnesses and more.(3) Homelessness and social exclusion have a serious impact on women's physical, mental and emotional health.

The purpose of this project, called Count Us In!, was to investigate how health and social services in Toronto, and in the province of Ontario, can be made more inclusive, and in turn, promote the health and well-being of marginalized groups. Homeless and underhoused women who live in Downtown East Toronto led the research and were actively engaged in all stages of the project, from collecting and analysing the data to developing the final recommendations.

They facilitated 11 focus groups with 58 women who are homeless or underhoused.(4) The researchers collected feedback on the health and social services that women use as well as the participants’ ideas about how policies and services could be improved. Count Us In! aims to influence how governments and service providers plan, deliver and fund services for populations that are marginalized. As one participant said, this is an opportunity for the service providers to "step back and take a good look at what is needed."

This report summarizes what the women said. It describes many of the barriers they face, and then highlights their solutions for making services more inclusive.

Key recommendations include:

• Training health and social service providers to listen to and respect the people they serve.
  
  
• Making information and resources readily available and accessible to women of diverse backgrounds.
  
  
• Creating safe spaces where discrimination is challenged and actively resisted.
  
  
• Setting up more detox centres and harm reduction programs for women.
  
  
• Opening more shelters for women and families.
  
  
• Making health and social services accountable to the people they serve.
  
  
• Changing policies that are detrimental to women's health and introducing policies that will give women more options – for example, build safe and affordable housing, provide more transitional supports for people who are moving from shelters to long-term housing, raise social assistance rates, and reverse the clawback on the National Child Benefit Supplement.

Count Us In! highlights the importance of marginalized women being actively involved in every part of the process, to ensure that their voices are heard, that they are "at the table," and that the appropriate actions are taken to meet their needs.

Download the Report (PDF, 381 kb, 33 pages)

1 See, for example, World Health Organization, Ottawa Charter for Health Promotion, Geneva, Switzerland: World Health Organization European Office, 1986 or World Health Organization, Belfast Declaration, Copenhagen: World Health Organization, 2003.

2 Health Canada, Taking Action on Population Health: A Position Paper for Health Promotion and Programs Branch Staff, Ottawa: Health Canada, 1998 or Health Canada, Healthy Development of Children and Youth: the Role of the Determinants of Health, Health Canada, 1999.

3 See, for example, Dennis Raphael, "Addressing health inequalities in Canada," Leadership in Health Services, 2002:15(3):1-8; D Raphael, S Anstice, K Raine, "The social determinants of the incidence and management of Type 2 Diabetes Mellitus: Are we prepared to rethink our questions and redirect our research activities?" Leadership in Health Services, 2003:16:10-20; and D Raphael, ES Farrell, "Beyond medicine and lifestyle: addressing the societal determinants of cardiovascular disease in North America," Leadership in Health Services, 2002;15:1-5.

4 The participants included women who live on the street, in shelters, in rooming houses or in other transitional housing. Locations covered in Downtown East Toronto are St. James Town, Cabbagetown, Church/Wellesley, Upper Jarvis, Regent Park, Moss Park, and St. Lawrence. Due to financial and time constraints, the project was conducted only in English and therefore does not adequately represent the voices of women who do not speak English, for example newcomers, refugees, women without citizenship status. Furthermore, while effort was made to recruit women from diverse backgrounds and experiences, this report does not claim to represent all women who are homeless and marginalized in Downtown East Toronto.

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