Housing Is a Health Intervention. BC's Health System Hasn't Caught Up With That Yet.
- IHSTS
- 2 days ago
- 3 min read
Written by Clare Koning RN PhD | June 2026
There is a tendency in health system planning to treat the social determinants of health as contextual background – important to acknowledge, outside the scope of clinical intervention, and ultimately someone else's responsibility. Housing is the most consequential example of where this tendency produces measurable harm.
BC has the highest core housing need rate in Canada, at 13.4% of households – compared to the national average of 10.1%. Core housing need means a household's accommodation is unsuitable, inadequate, or unaffordable, and they cannot afford alternatives in their community.
This is not a fringe population. It is one in seven BC households.
The health consequences are not abstract. A 2025 rapid review of 55 studies published between 1991 and 2025 found that housing insecurity is consistently associated with adverse health outcomes across every life stage – from pregnancy and infancy through childhood, adolescence, adulthood, and older age, with each stage presenting distinct vulnerabilities shaped by environmental and social conditions.
Children in housing-insecure households have worse physical and mental health outcomes. Adults in precarious housing have higher rates of chronic disease, mental illness, and substance use. Seniors without stable housing face dramatically accelerated functional decline. None of this is fixed by a prescription or a referral.
Food Insecurity Is the Housing Crisis's Twin
Housing insecurity and food insecurity are structurally linked. Approximately 20% of low-income Canadians spend more than 50% of their income on rent, leaving insufficient resources for nutritious food. In 2024, household food insecurity affected 25.5% of people in Canadian provinces – a figure that reflects not just pandemic-era inflation but a long-standing structural inadequacy in income supports and housing costs.
Food insecurity is associated with poorer mental health, increased risk of infectious and non-communicable diseases, poorer disease management, higher healthcare use, and premature mortality. The relationship is graded: more severe food insecurity is associated with greater likelihood of negative health outcomes and higher healthcare costs, independent of income, education, and other determinants. A person cannot effectively self-manage type 2 diabetes if they cannot afford the food required to follow the dietary guidance they receive from their physician. The clinical intervention is not wrong. The context it lands in makes it insufficient.
What Health Systems Can Actually Do
The argument is not that health systems should become housing providers. It is that health systems cannot achieve the population health outcomes they are accountable for while remaining institutionally indifferent to the social conditions that generate those outcomes.
BC's CMHA has argued, correctly, that mental health services function as essential social and economic infrastructure, and that stable housing is foundational to recovery, workforce participation, and long-term system sustainability. The same logic applies to chronic disease management, palliative care, substance use treatment, and virtually every other area where health systems invest resources that are undermined by unstable housing.
Practically, this means health systems investing in screening for social determinants of health at the point of clinical contact – not as a gesture, but as a trigger for coordinated social support referrals. It means community health centres designed to deliver primary care alongside social services.
It means active, formalized partnerships between health authorities and housing agencies.
And it means health system leaders adding their institutional voice to the policy arguments for housing investment, because the costs of inadequate housing flow directly into their emergency departments, mental health systems, and long-term care waitlists.
The health system is paying for the housing crisis. It has a stake in solving it, and a responsibility to say so clearly.
IHSTS advocates for health system approaches that address the social determinants driving chronic disease and health inequity in BC communities. Learn more at ihsts.ca.
