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Homelessness & Health in Canada

Manal Guirguis-Younger
Ryan McNeil
Stephen W. Hwang

Part I-Homelessness & Health in Canadian Populations

Chapter 4. Homelessness and Health in the Crowded Canadian Arctic: Inuit Experiences

Nathanael Lauster and Frank Tester

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1The experience of homelessness for Inuit in the Eastern Arctic is the culturally mediated product of a history of displacement compounded by a serious shortage of affordable housing. Despite prominent photographs to the contrary in the national media (Paperny and Minogue 2009), homelessness in Nunavut is made most visible not by people sleeping in the streets but by extraordinarily high levels of residential crowding. However, key measurements of residential crowding only capture a portion of Inuit experiences of homelessness. In this chapter we explore Inuit experiences with four objectives. First, we present the cultural context and history of policy development relevant to housing in the Eastern Arctic. We then seek to better define what homelessness means, laying out different dimensions of homelessness and matching them to Inuit experiences. Third, we use the results of an innovative community-based survey, designed with local input, to estimate the prevalence of different types of homelessness in Nunavut and how these relate to more conventional measures. Finally, we establish relationships between homelessness and health issues in Nunavut, captured in the same community survey. Overall, we underscore the importance of housing as foundational in addressing a number of health-related problems in the Eastern Arctic. We also suggest that while conventional measures reveal some of the need for housing in Nunavut, they understate the overall experience of homelessness and miss important connections to health.

Housing in Nunavut: Cultural Context and History of Policy

2The following paragraphs provide a glimpse of what the transition to settlement life meant for many Inuit. They are presented as a composite of experiences, relayed to researcher Frank Tester in discussions with elders over years of researching the social history of Nunavut.

The dogs were curled about in the snow, a slight north wind stretching across the Barrens. The entrance led down slightly, a tunnel through the walls he built two months earlier. The kudlik, or seal oil lamp, a base carved of soapstone and a wick from last summer's cotton grass was off to one side, frozen char and seal on the other, with a warm and familiar bench across the igloo's back, spread with several layers of skins from last fall's caribou hunt. Each family member had their designated spot, including hers, next to the kudlik, burning all day, all night, as long as there was seal oil to be had.
The bench was a place for games; for children to play with tiny bone and ivory carvings, some passed down from grandfather (
ataatattiq) to child (pariaq). The next day, weather permitting, would be another at the floe edge; another day with dogs, raised from pups and harnessed to the komatik (sled) he'd made last winter with driftwood and pieces from the Qallunaat's (white person's) packing crates left behind the Hudson's Bay Post, three sleeps down the coast. It had been a tough winter. Bad storms (uannaq) had kept him away from the floe edge and the kudlik was burning low. It was a world, sometimes warm, but when not, still glowing with the satisfaction of things—skinning a seal or making new leads for the dog team—well done.
It was the winter before the plane came, skimming across what had, only a few weeks before, been a small bay (
ikirasaq) full of floating ice. It carried the Reverend Father and the rcmp [Royal Canadian Mounted Police] Constable who had come to take Peter away to the Qallunaat school. He had to go. No choice in the matter. Neither he nor his wife could stand the thought of Peter, four, maybe five sleeps away, learning—what? To make a decent harness for the dogs? To set a successful fox trap? To find the right snow for building a home?
After a few months they followed where he'd gone. Now theirs was a government-supplied plywood home. The door didn't quite fit. When it opened, the outside came in with a vengeance. The space heater fought the icy draft; a losing battle. The floor was cold, the ceiling sweaty. Money was needed for rent and fuel. The
rcmp officer who provided family allowances and the social assistance that paid the bills was to be feared—and respected. He was surrounded by all that was no longer needed: his skill with a snow knife, her way of rolling cotton grass wicks, and dogs. What to do with a team that was hard to feed; confused in the presence of Inuit they'd never responded to before, and viewed with suspicion by a rifle-toting Mountie, threatening to shoot if some means was not found to tie them up.

3This scenario captures one of the circumstances that brought Inuit into settlements and the feelings of 'being useless' that often accompanied the move. Commencing in 1949, the federal government introduced a policy of providing Inuit children with an education designed to prepare them for entry into modern Canadian society. Through the 1950s, Inuit parents were increasingly pressured to send their children to federal day schools and church-run residential facilities. Inuit parents often followed their children, fearing what might become of them, and not willing to trust their children to the hands of strangers. Inuit also moved because they could no longer make a living on the land. Following the Second World War, the price of Arctic fox pelts and the trapping economy collapsed (Tester and Kulchyski 1994).

4There were other reasons for moves to the settlements. Epidemics of disease, notably, tuberculosis and bouts of measles, whooping cough, diphtheria, chicken pox and influenza, made being in the vicinity of a nursing station useful. By the late 1960s, the migration of Inuit off the land was virtually complete. Inuit went from their homes—tents, igloos, qamaqs (sod homes) and a landscape they knew well—to clustered shacks made of scrap building materials, often gleaned from dumps at American-built radar stations. One energetic public health officer, in 1957, after touring the Eastern Arctic aboard the C. D. Howe, making its yearly visit with supplies and a party of physicians, nurses, dentists and X-ray technicians to check on 'Eskimo' health, compared what he saw to the worst slums of India, where he had served in the past (Tester 2006).

5The northern administration introduced its first housing policy for Inuit in 1959, providing rigid frame, plywood one-room houses of 192 square feet. The rigid frame design (incorporating unnecessarily sloped roofs) was soon replaced by a variety of flat-roofed homes, affectionately known as matchboxes, a nickname reflecting their shape. The northern administration, fearing the 'dependency relations' that were imagined to develop should housing be given to Inuit, came up with a rent-to-own initiative. The houses cost about $1,500. Inuit were to pay $10 a month toward ownership, $500 being granted as a subsidy. Yet it cost about $50 a month to heat one of these units, and as a result few could keep up with the payments. As rent-to-own homes were converted to welfare units, record keeping became challenging. The units were poorly insulated and vented. They had no sanitary provisions other than a pail or 'honey bucket' lined with a green plastic garbage bag that was left outside when full. The water supply consisted of an indoor plastic tank that could be filled with water or ice to be melted down (Tester and Kulchyski 1994).

6In Arviat (Eskimo Point), an epidemic of tuberculosis broke out in 1963 and was traced in large part to the appalling housing conditions (Moore 1964). Thirty-two percent of the community was ultimately evacuated to southern sanatoria for treatment. The cost was equivalent to providing the entire Eastern Arctic with three years' worth of housing. The rent-to-own policy was replaced in 1965 by the Eskimo Rental Housing Program. It provided Inuit with homes of up to three bedrooms with rent geared to income and house size and configuration to need. At the time, it was estimated that 1,600 homes were needed to properly house Inuit. In 1968, the federal government handed responsibility for the administration of social housing over to the Government of the Northwest Territories (gnwt). The gnwt integrated the initiative with a similar one in the Western Arctic and changed the name to the Northern Rental Housing Program.

7Between 1968 and the present, housing policies in the Eastern Arctic have been marked by various attempts at encouraging home ownership. These policies have been costly, funnelling resources away from social housing (Hulchanski 1988), and have mostly failed to achieve their goals in the face of unsteady employment opportunities and low wages relative to the costs of housing. According to Statistics Canada 2006 census data, over 75 percent of households in Nunavut were renters. Commencing in 1981, Section 40 of the National Housing Act was used to fund public housing in the Northwest Territories. The Central Mortgage and Housing Corporation (cmhc) paid 75 percent of the capital costs of construction and 75 percent of the operating deficits. The capital cost provisions of this agreement were cancelled in 1993, and cmhc support for the maintenance of public housing is to decline to zero by the year 2037. Between 1992 and 1997, the gnwt spent $160 million on 1,435 social housing units in an attempt to address the growing housing shortage (Bourgeois 1997). Yet, by 1997, shortly before the new territory of Nunavut was carved out of the Northwest Territories, an estimated 4,350 new units were needed to meet the Northwest Territories' social housing needs, including the replacement of old stock (Northwest Territories Housing Corporation 1997). The response of the Northwest Territories' finance minister was to inject even more funding ($40–$50 million) into another home ownership program (Bourgeois 1998).

8By 1999, the newly formed government of Nunavut had an estimated list of 1,231 households waiting for social housing. The Nunavut Housing Corporation (nhc) was created in 2000 to create, administer and coordinate housing programs in the territory. The 1,231 Inuit households on the wait list confronting the newly formed corporation were distributed among fewer than 5,600 existing households (5,665 households were enumerated in the 2001 Aboriginal census for Nunavut two years later). Given that all materials must be imported from the south and designs must address Arctic conditions, the costs of Arctic construction are considerable. In 2006, the federal government provided Nunavut with $200 million to build some 725 new units of affordable housing through the Nunavut Housing Trust (oag 2008), at an average cost of $275,000 per unit. Unexpected labour and material costs added another estimated $75,000 to the cost of each (Windeyer 2010b). No funds were allocated for the operation and maintenance of the units. The $350,000 price tag of these dwellings compared to the $16,069 median income for Inuit aged 15 years and older (Statistics Canada 2006) provides insight into the reasons the severely limited stock of social housing dominates housing options for residents of Nunavut. By September of 2010, it was estimated that the $200 million Trust program set up to address the considerable social housing needs of Nunavummiut was $110 million over budget (Windeyer 2010a).

Dimensions of Homelessness

9Prominent definitions of homelessness, such as that offered by the United Nations, emphasize physical shelter from the elements in a unit meant for human habitation and a secure location for one's possessions so they need not be carried from place to place (Hill 1991; Springer 2000; United Nations 1998). These often become working definitions for surveys of homelessness, focused on where people last slept or what services they've used (Peressini, McDonald and Hulchanski 1995). These definitions may be broadened to incorporate those living in inadequate shelter, usually defined with reference to tenure and physical security, privacy, space, basic services (water supply, sanitation, etc.) and affordability (Springer 2000).

  • 1 Only 12.9% of non-Inuit households in Nunavut experienced core housing need in 2006.

10In the Canadian context, being defined by cmhc as in "Core Housing Need" incorporates aspects of affordability, suitability (having enough bedrooms given household composition) and adequacy or state of repair (cmhc 2009a). Households are counted as being in core housing need if they do not meet the minimum thresholds for affordability, suitability and adequacy and are unable to afford local accommodation that meets these thresholds. According to these criteria an estimated 12.7 percent of households across all households in Canada and an estimated 44.7 percent of Inuit households in Nunavut in 20065 (cmhc 2009a) are in core housing need.1 Those in core housing need and currently spending at least half their income on shelter costs have been identified as at risk of homelessness (Fiedler, Schuurman and Hyndman 2006).

11While affordability drives the prevalence of core housing need in most parts of Canada, suitability is clearly the main driver in Nunavut. The measurement of suitability emphasizes privacy, home as a sanctuary and having a room of one's own (Lauster and Tester 2010). 'Home' has also acquired broad meanings as a symbol and stage for making claims to social belonging and inclusion (Hopper 1997; Mallett 2004). In this sense, acquiring a home may be related to the development of family and adult identity (Goldscheider and Goldscheider 1999; Lauster 2006). Together, the ideas of home as sanctuary and home as symbol relate to Goffman's notions of the back stages and front stages required for putting on successful social performances (Goffman 1959). In effect, people are always performing social roles for one another and they need spaces to both prepare their performances and to enact them. In this sense, home is a meaning-making tool. Correspondingly, being homeless means being unable to put on successful social performances, resulting in stigmatization and a sense of meaninglessness. Home as belonging is also tied to a sense of community and country, locating people in a homeland and way of life (Mallett 2004).

12As varying definitions serve to indicate, the idea of 'home' used to define 'homelessness' remains highly subjective, often contested, malleable in definition and strongly dependent upon context (Hopper 1997; Kellett and Moore 2003; Mallett 2004). The ambiguity of the concept has driven at least one researcher to suggest replacing homelessness with 'houselessness' as a social problem, privileging more objective measures of shelter as definitional in order to enable cross-cultural comparisons (Springer 2000). Yet both what is seen as a problematic housing circumstance and what is seen as home are necessarily culturally specific. Consequently, we suggest that the best way to account for cultural difference in understandings of homelessness is not to ignore difference but to ask people in varying contexts about the problems they face in feeling at home throughout their daily lives.

13In this sense we define homelessness as multidimensional, corresponding to problems in achieving various subjective experiences of feeling at home. From the literature reviewed above, we take the experiences of feeling at home to mean feeling: (1) sheltered from the elements, (2) physically secure, (3) secure in the storage of one's possessions, (4) secure in one's privacy, (5) a sense of belonging and meaning and (6) a connection to one's homeland. We define problems encountered in producing these feelings as problems of homelessness. Below we apply this understanding of dimensions of homelessness to the lived experience of Inuit in Nunavut, taking into account the crucial importance of cultural context, to estimate the prevalence and impact of homelessness.

The Experience of Homelessness in the Eastern Arctic: The Kinngait Harvest Society Survey

14Given the sketch of homelessness above, we use the results of a community-developed survey in Kinngait, Nunavut (formerly Cape Dorset) to estimate the prevalence of different forms of homelessness in the Eastern Arctic and to understand their relationships with health. Kinngait is one of 25 communities making up Nunavut, and in 2006 it contained just over 4 percent of the territory's population (1,236 people). It is located in the southwest corner of Baffin Island (Qikiqtani). According to the most recent census, over 90 percent of the community's population is Inuit. Approximately 85 percent of the housing is rented social housing. The official unemployment rate was high in 2006, at 25.3 percent, and the median annual income for Inuit members of the community, age 15 and older, was $12,672. Median household incomes were higher at $35,200, but still far below the median for the country as a whole ($52,634).

  • 2 Assuming approximately two persons per household on the waiting list.

15In 2005, researcher Frank Tester worked with community members from Kinngait to create and administer a questionnaire exploring the housing situations and the physical and mental health of residents. Sampling for the survey was stratified by categories of age, sex, family status (couple vs. single) and position on a housing waiting list. Households in the community were numbered and selected randomly until a household with a member meeting stratification criteria was found. That member was selected to be interviewed in the survey and the household was not replaced. As a result, some 91 residents of Kinngait (age 15 and older) were surveyed, reflecting 91 different households in the community. Overall, the sample is somewhat younger and more dominated by women than both the population of Kinngait and Nunavut as a whole, though it also has a slightly higher representation of residents over age 55. Census estimates for age–sex categories allow the sample to be re-weighted to correspond to the population distribution in Nunavut, and these results are reported in the analyses that follow, where indicated. The sample proportion in common-law and marital unions (49%) lies between the proportion reported in the 2006 census for Kinngait (47%) and for Nunavut as a whole (52%). Similarly, the sample proportion drawn from the waiting lists (14.3%) lies between that of the proportion of Inuit (15 years or older) on the waiting list estimated for Kinngait (12.2%), and the proportion estimated for Nunavut as a whole (using 1999 estimates, this would be approximately 15.9%).2

16Community participation in the design of the survey incorporated local understandings of both the meaning of home and the related problems associated with feeling at home. Given the hunting culture of Inuit and that many Inuit lived on the land until the mid-1960s, we suggest a connection to one's homeland is especially important in the Eastern Arctic. The capacity to return to the land and a more traditional way of living away from settlements—spending summer and even long winter periods out of settlements and in cabins scattered along the coast in areas traditionally occupied—helps many Inuit "feel better" and "at home". Table 4-1 details the survey responses as they relate to these problems. The nature of the survey, based in local experience, helped avoid situations where language and concepts imported from southern Canada fail to make sense to local residents and broadened the range of topics considered, to include culturally specific concerns. A fuller description of the survey design is available in the report Iglutaq: The Implications of Homelessness for Inuit by Tester and the Harvest Society (2006).

Table 4-1. Homelessness dimensions as measured by equivalent survey item responses

Homelessness Dimension

Equivalent Survey Responses

Lack shelter from elements

"I need a different house because it's too wet here" or "this house is cold or very cold, causing sickness or making us stay at someone else's house"

Lack physical security

"I do not sleep at home because of problems at home, or because I have nowhere to sleep there" or "violence is a problem related to my housing circumstance"

Lack security for possessions

"Someone sold furniture/appliances/equipment from house because of gambling, drug use, drinking, needing $ for food, etc."

Lack privacy

"I never have time alone or privacy"

Lack belonging

"Someone in my house needs to have a house of their own" or "I don't have a bedroom / sleep on the couch, etc."

Lack access to land

"I lack the equipment I need to get out on the land, and it is not okay"

Measurement and Prevalence of Experiences of Homelessness

17The extreme weather of the Arctic climate means that occupying a dwelling meant for human habitation, including a roof and walls, may not be enough to fully protect one from the elements, especially the cold and wet. Thirty-three percent of the respondents felt a lack of protection from the elements by these measurements, roughly matching the census estimates of 29 percent of occupied units in Kinngait needing major repairs in 2006 (Statistics Canada 2006). This compares to 23 percent of Nunavut's Aboriginal households as a whole needing major repairs in the cmhc estimate (cmhc 2009b).

18We interpret physical security to mean having a stable place to stay, especially to sleep, where one can feel safe. Many Inuit reported sleeping away from home simply because they felt like it, reflecting the cultural flexibility of sleep arrangements for Inuit households and the difficulty of applying measurements of household suitability derived from elsewhere (Lauster and Tester 2010). But others reported sleeping away from home because of problems or lack of space, or they otherwise reported violence as a problem at home. Altogether, some 15 percent of the sample felt a lack of physical security according to these measurements. Given that recent data on the rate of violent crime in Nunavut is over eight times the Canadian average (Statistics Canada 2006), it may not be surprising that nearly one-sixth of the sample feels a lack of physical security in their housing situation.

19Rates of breaking and entering are about four times higher in Nunavut than for Canada as a whole (Tester and the Harvest Society 2006), but we have little data on experience with breaking and entering from the survey. Instead, we have data on whether or not a household member has ever sold any "furniture, appliances, or equipment" from the respondent's house because of various immediate needs. Living in a household where household items needed for daily living might be sold at any time to cover costs for any of the items listed (and needing money for food was by far the most commonly reported reasons) constitutes a problem, leaving residents feeling insecure about their tenure. This possibility affected 32 percent of the sample respondents.

20Given the widely acknowledged residential crowding in Nunavut, it is unsurprising that many Inuit reported feeling a lack of privacy. The survey asked those reporting that their housing situation was crowded, what problems this made for them. Those responding with "I never have time alone or privacy" as a problem were considered to be lacking in privacy, including 33 percent of the sample.

21To measure lacking belonging, we focus on someone in a household being seen as needing a place of their own as a potential indicator of the lack of an opportunity to define oneself and, consequently, to belong to a family or community as both a member and contributing individual. Such individuals do not 'fit' in the household in some way, either because they are seen by other household members to be old enough to have their own place or because they make too much noise, they argue too much with a romantic partner, they are lazy, they disrespect their elders or some other reason. The sense of lack of belonging generated by this bad fit creates a feeling of homelessness, both for the household member who does not seem to fit, and for other household members who must deal with them, often being denied the respect they feel they should be accorded in the process. In the case of those old enough to have a place of their own, the lack of belonging is double-edged. By being denied a place of their own, they are also denied a place in the world of adults befitting their age. As a separate indicator of those not 'fitting' into a household, we include as lacking belonging those who do not have a clear space of their own in their housing situation, sleeping on the couch, the floor or some other location. In total, some 40 percent of the sample experienced a lack of belonging defined in these ways. This is the most prevalent form of homelessness we record, likely linked to the long waiting lists for public housing units across all Nunavut communities.

22Finally, we consider the lack of access to the land as a dimension of homelessness for Inuit. Inuit are a hunting culture and despite attempts at acculturation, Inuit identity and social relations are still tied to hunting and 'life on the land'. Some 25 percent of the sample, mostly older respondents, indicated that they lived on the land before moving into the community. The land also supports a traditional way of life and the historic sources of food important to Inuit culture. Over 5 percent of Inuit reported returning to living on the land for a while since first moving to the settlement, either for better hunting, because they thought the traditional way of living was better or they missed it or because they simply wanted to get away from the community. However, it takes special equipment to get out onto the land. Respondents were asked whether or not they had the equipment needed to get out onto the land. Of the 36 percent of respondents who did not have the equipment, some reported feeling "okay" about not being able to go out. We considered those who did not feel "okay" about not having the equipment to get out on the land as lacking access to the land.

23Table 4-2 provides estimates of the prevalence of homelessness by these various measures. An estimate of the percentage of households in core housing need is also included in this table. Data from the survey do not allow an easy calculation of affordability for the sample. But the Canadian Housing Observer estimates for core housing needs in Nunavut indicate that this is the least important criteria for the territory (despite being the most important criteria determining housing needs in every province in Canada). The sample estimate of core housing needs is drawn from questions about household composition and bedroom numbers, taking a conservative estimate of the number of bedrooms required to meet Canadian National Occupancy Standards given the age and relationship status of household members (suitability), and questions about whether or not respondents need a new dwelling because of repair issues involving their current dwelling (adequacy). Overall, the sample estimate of those in core housing need matches well with the territorial estimates provided by the Canadian Housing Observer (cmhc 2009b).

Table 4-2. Estimates of homelessness prevalence by dimension amongst those over age 15

Table 4-2. Estimates of homelessness prevalence by dimension amongst those over age 15

*Core housing need refers to % of Inuit households rather than % of individuals. Estimated Nunavut data on core housing needs drawn from the Canadian Housing Observer.
Source: "Characteristics of Households in Core Housing Need, Nunavut, 2006" (cmhc, 2009b). No confidence intervals are provided, though estimates are based on approximately 1 in 5 household census sampling

24Both estimates (sample and territorial) of core housing need suggest that the size of the at-risk-of-homelessness population, as may be currently considered by policy-makers, is higher than any single dimension of homelessness discussed above. However, considering that the coincidence of dimensions, as in Table 4-3, suggests that overall most Inuit—an astounding 87 percent—are likely to experience some dimension of homelessness, with about 30 percent experiencing three or more dimensions of homelessness. As a result, policy-makers are likely to underestimate the prevalence of homelessness amongst the Inuit. Notably, the dimensions of homelessness measured here tend to be positively correlated with one another, but the correlations are not high (the highest is 0.27). Creating an index of homelessness by combining dimensions provides an overall alpha that's relatively low (0.396) indicating that different dimensions are indeed being tapped by each indicator.

Table 4-3. Coincidence of homelessness dimensions (homelessness index alpha = 0.396)

Table 4-3. Coincidence of homelessness dimensions (homelessness index alpha = 0.396)

25All homelessness dimensions except for 'Lacking shelter' and 'Lacking access to the land' are positively and significantly (p < 0.05) correlated with being in core housing need, but again the correlations are relatively low (the highest is 0.27). As in Table 4-4, combining all the dimensions into the single homelessness index yields a higher and statistically significant correlation of 0.38 to core housing needs, but the relationship between experiential measures of homelessness and core housing need measures indicates that much of the experience of homelessness in the Eastern Arctic is currently not being accounted for by cmhc measures. Other seemingly objective crowding measures (also included in Table 4-4) perform similarly or worse, failing to capture the full range of the homelessness problem in Nunavut, as described above. Survey respondents were asked directly about whether or not they subjectively felt they lived in a crowded house. For the 47 percent of respondents who felt they lived in crowded circumstances, over a third (35%) indicated they had no problems with it. A substantial minority (18%) of those experiencing crowding said they even liked having all the people around. Crowding is clearly a primary driver of the high prevalence of homelessness amongst Inuit, but the experience of homelessness is not entirely about crowding, nor is it fully captured by culturally ignorant measures of the phenomenon that fail to take into account Inuit experience (Lauster and Tester 2010).

Table 4-4. Other measures of housing need and crowding from survey (weighted to Nunavut age/sex distribution)

Table 4-4. Other measures of housing need and crowding from survey (weighted to Nunavut age/sex distribution)

*Other than partner

Homelessness and Health in the Eastern Arctic

26A number of studies have linked crowding and aspects of housing situations in the Canadian North to health issues. Most prominently, researchers have linked tuberculosis (Clark, Riben and Nowgesic 2002; Lodge et al. 2006) and respiratory infections in children (Kovesi and Gilbert 2007) to housing circumstances and crowding. A larger literature has also linked psychological distress to crowding (Evans 2003). Here we extend this work by exploring the link between dimensions of homelessness and a more diverse set of health-related outcomes, as reported by respondents.

27The survey asked, broadly, about various indicators of the health of Inuit respondents. In particular, the survey identified a set of ailments understood within the community to be health related and asked respondents whether or not they experienced them. The survey also asked about encounters with other key problems. Items are listed in Table 4-5. The separate items within each list were added together to create a health issue index (combining the former items, α = 0.7018) and a more general problem index (combining the latter items, α = 0.4275). Separate items and combined indices were subjected to a correlation analysis with dimensions of homelessness and the homelessness index, as well as with the indicator for core housing needs. Table 4-6 reveals the significant correlations emerging from this analysis corresponding to each measure of homelessness. In all cases, correlations to health issues and problems are positive.

28Notably, every dimension of homelessness is significantly correlated with a set of health conditions and related problems. Moreover, each of the problem sets associated with different dimensions of homelessness is unique to that dimension. The problem index, obtained by combining the items of problems with drinking, violence, depression, drug use, problems with school, problems with work and people being angry, was significantly associated with all dimensions of homelessness. By contrast, the health issue index was not associated with all dimensions of homelessness but seemed at least marginally related to lacking security of possessions, lacking privacy and lacking access to the land. Combining every dimension of homelessness together into a single index produced particularly powerful relationships to the broadest swath of problems and issues raised by respondents. Higher scores on the homelessness index were correlated with experiencing cold sores, flu, poor sleep, drinking, violence, depression, drug use, school problems and problems with people being angry. In this way, the homelessness index proved far more comprehensive than the measure of core housing need derived from the survey as roughly equivalent to cmhc measurements. Again, the core housing needs designation seems to capture some of the issues related to homelessness in Nunavut, but by no means all of them.

Table 4-5. Items measuring health conditions and related problems

Health Conditions

Related Problems

Do you get cold sores?

Do you have any problems with:

Do you get the flu?


Do you get colds and coughs?


Do you have tuberculosis?


Do you have cramped muscles or body pain?

Drug use?

Do you have poor sleep?

Problems with school?

Do you have skin problems?

Problems with work?

Do you suffer from stress?

People being angry?

Do you get migraines or headaches?

Do you have other health conditions?

29The significant positive correlation between the homelessness index and both the health issues index and the problem index (treated as dependent variables) persists after controlling for age, gender, presence of a partner, presence of children and schooling in ols regression models (not shown here). By contrast, when our measure of core housing needs is introduced in the model, it does not attain significance, but the significant effect of the homelessness index remains. Including each dimension of homelessness separately in regression models, treating the problem index as the dependent variable, indicates that each retains significance by itself and almost all retain significance in combination with one another. However, when treating the health issue index as the dependent variable, separate dimensions of homelessness do not attain significance. Overall, multivariate regression results support the significance of the bivariate correlations shown here and are available from the first author upon request.

Table 4-6. Links between homelessness measures and health conditions or related problems

Significantly Positive Correlations

Lack shelter from elements

problem index, headaches, other health issues, stress, depression, drug use

Lack physical security

problem index, cold sores, violence*, drug use, drinking, depression, anger

Lack security for possessions

problem index, violence, drug use, school problems, health issue index, cold sores, drinking

Lack privacy

problem index, poor sleep, depression, health issue index, school problems

Lack belonging

problem index, drinking, violence, drug use

Lack access to land

problem index, violence, poor sleep, depression, work problems, anger, health issue index, drinking

Homelessness index

health issue index, problem index, cold sores, poor sleep, drinking, violence*, depression, drug use, school problems, anger, flu

Core housing need

health issue index, problem index, poor sleep, school problems, flu

Note: Italicized health-related problems are marginal (0.05 < p < 0.10) in the significance of their correlation.
*Listing violence as a problem related to housing is included as part of the definition of homelessness in this case

Community Perceptions of Links between Homelessness and Health

30Finally, respondents in the survey were also asked directly whether or not they thought any of their health issues related to their housing circumstances. Table 4-6 summarizes the results. Headaches and tuberculosis were experienced by a very small portion of respondents but were readily linked to housing situations by those respondents. Of more common ailments, poor sleep and stress were most often linked to housing situations, but all health issues were linked to housing situations by at least some respondents. A similar question was asked about overall health, linked more specifically to whether or not respondents felt their health would be better with more space. Over half of respondents (57% weighted to Nunavut distributions) felt that their health would improve with more space.

31Table 4-7 summarizes similar results for other problems. Here the wording of the question about links to housing situation was closely tied to whether or not fewer people in the house would help the problem. Overall, problems were more consistently linked to housing situation than health issues. Problems with violence were most often thought to be fixable with fewer people in the house (over four-fifths of respondents experiencing problems with violence felt this way). By contrast, only about a fifth of respondents felt drug use problems would be fixed by fewer people.

Table 4-7. Links between health conditions and housing situation, as perceived by respondents (weighted to Nunavut age/sex distribution)

% Experiencing

Of Those Experiencing, % Linking to Housing

Cold Sores












Poor Sleep



Skin Issues









Other Health



Table 4-8. Links between related problems and the number of people in the house, as perceived by respondents (weighted to Nunavut age/sex distribution)

% Experiencing

Of those Experiencing, % Linking to Number of People in House










Drug Use



School Problems



Work Problems



People Being Angry




32By all reliable accounts there is a housing crisis in Nunavut. The territory has the highest rate of core housing needs in Canada, well over twice its nearest competitor, the Northwest Territories (cmhc 2009a). Our analyses estimate that a shocking 87 percent of Inuit experience some form of homelessness, dimensions of which are strongly tied to the housing crisis. Dimensions of homelessness are also strongly correlated with a wide range of health problems. The costs associated with building and maintaining enough decent and affordable housing in the Eastern Arctic to ease the housing crisis have often been far outweighed by the costs of dealing with the various health problems associated with homelessness.

33At the same time, the ways in which the lack of housing in Nunavut affects people are not quite the same as the way the housing crisis is measured by estimates of core housing need. Those in core housing need are often treated as being at risk of homelessness (Fiedler, Schuurman and Hyndman 2006). In the case of Inuit living in Nunavut, we suggest that most of those classified as being in core housing need are, in fact, experiencing multiple dimensions of homelessness. Strikingly, this is also true for many Nunavut residents who would not be considered in core housing need.

34In Nunavut, homelessness is the result of a particular history of displacement, as well as a history of inadequate resources for housing, mapped onto a shifting cultural definition of home. Thinking about homelessness in terms of various dimensions of the meaning of home provides a powerful way to incorporate history and culture into definitions. The result of Nunavut's history and culture is that sizable portions of the population of Nunavut feel they lack shelter, security, a place to store their property, privacy, a sense of belonging and any way to feel connected to their ancestral lands and the way of life that makes them feel Inuit. In a very real sense, these are the dimensions of homelessness of relevance to the Inuit population of Nunavut. The housing problems of Nunavut are rooted in material circumstance, but these material circumstances, in turn, are culturally interpreted as they are experienced in everyday life.

35Each of the dimensions of homelessness we specify and attempt to measure here were correlated with aspects of health and wellbeing. Each of the dimensions also remained distinct from the other dimensions of homelessness measured. It seems clear that homelessness is a multifaceted experience, at least in the context of the Eastern Arctic.

36We provide only rough estimates of the size of the population in Nunavut experiencing homelessness. These estimates come with many qualifications, especially since we attempt to generalize from the experiences recorded in only one of Nunavut's 25 communities. Nevertheless, we argue that the survey analyzed here provides valuable results for the study of homelessness in Nunavut. We suggest that one of the problems encountered in studying relationships between homelessness and health is the lack of attention provided to how culture matters. The experience of home and problems associated with achieving it are culturally mediated, as ultimately are experiences of health. One particularly valuable aspect of the survey analyzed here is that it was constructed with significant input from the community members being studied. As a result, the findings of the survey better reflect local understandings of homelessness and health than would be the case for a survey designed without this input.

37This is a direction that needs to be pursued further. Since the nhc was created in 2000, there have been a number of detailed studies of housing in Nunavut territory. These include the 2009–2010 Nunavut Housing Needs Survey and a report on the nhc prepared by the Auditor General of Canada and released in May of 2008. These documents do a credible job of detailing the extent of overcrowding noted in the report used to frame this chapter. The statistical information collected in these studies meets primarily the managerial needs of the nhc. Their findings are important. The recommendations made by the Auditor General of Canada include: improved training for the local housing authorities responsible for total management of social housing at the community level, ensuring that the rating system for determining priorities in the provision of social housing are actually applied, taking steps to ensure that eligibility criteria are met and updating manuals and procedures and ensuring that proper procedures are followed in maintaining and reporting on the condition of social housing stock. These are all important to making the existing system work better.

38But the Inuit experience of home—what it is, how it works, what it means, how its provision might be changed and improved—merits more attention. The research presented in this chapter attempts to moves in this direction. The Nunavut housing situation is characterized by considerable need and inadequate resources. The withdrawal of cmhc maintenance funds for social housing over the next 25 years will place considerable additional financial pressure on the nhc. A report prepared by the Government of Nunavut and Nunavut Tunngavik Incorporated (2004) estimates that it would take the unlikely sum of $1.9 billion invested between 2006 and 2016 to bring housing in Nunavut up to Canadian standards. This is an unlikely investment, suggesting the need for a radically different approach to dealing with overcrowding (homelessness) in Nunavut. If 'home' is about meaning-making and belonging, if self-esteem is tied to what one accomplishes in the creation and management of space, then Inuit need both the pride and responsibility of 'ownership' in a situation where conventional ideas about ownership are unrealistic. These considerations suggests the merit of exploring radically redesigned cooperative or co-housing associations, perhaps defined in relation to extended family units involving otherwise unemployed coop members in construction, management and maintenance of units for which they have a budget and responsibility, with the nhc providing technical, managerial and related assistance. While the details and complexities of such a program are considerable, the current social housing program operating in Nunavut is unsustainable, suggesting that alternatives integrating social, cultural and health—as well as conventionally understood space-related needs—are in order.



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1 Only 12.9% of non-Inuit households in Nunavut experienced core housing need in 2006.

2 Assuming approximately two persons per household on the waiting list.

List of illustrations

Title Table 4-2. Estimates of homelessness prevalence by dimension amongst those over age 15
Caption *Core housing need refers to % of Inuit households rather than % of individuals. Estimated Nunavut data on core housing needs drawn from the Canadian Housing Observer.Source: "Characteristics of Households in Core Housing Need, Nunavut, 2006" (cmhc, 2009b). No confidence intervals are provided, though estimates are based on approximately 1 in 5 household census sampling
File image/jpeg, 132k
Title Table 4-3. Coincidence of homelessness dimensions (homelessness index alpha = 0.396)
File image/jpeg, 96k
Title Table 4-4. Other measures of housing need and crowding from survey (weighted to Nunavut age/sex distribution)
Caption *Other than partner
File image/jpeg, 76k


Associate Professor of sociology at the University of British Columbia. His research focuses on social aspects of the built environment, especially as it concerns the use of housing. In addition to work on crowding, housing and health in Nunavut, he has published many articles on the interrelationships between family formation and housing and recently co-edited a book, The End of Children? Changing Trends in Childbearing and Childhood (ubc Press)

Professor of social work at ubc and Adjunct Professor of Native Studies, University of Manitoba. His research focuses on Nunavut and the Inuit of the Canadian Arctic. He is co-author of Tammarniit (Mistakes): Inuit Relocation in the Eastern Arctic 1939–62 and Kiumajut (Talking Back): Game Management and Inuit Rights 1900–70, both published by ubc Press. Dr. Tester is a recipient of the Gustavus Myers Award for the Study of Human Rights in North America and the Erminie Wheeler-Voegelin Prize from the American Society for Ethnohistory, Cornell University

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