Housing Crisis, Packed Hospitals and Food Lines: Even in Canada?

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Housing Crisis, Packed Hospitals and Food Lines: Even in Canada?

From Montreal to Vancouver, some residents are losing faith in a longstanding social safety net that is central to the country’s identity.

March 27, 2024 at 10:00 AM GMT+9

https://www.bloomberg.com/graphics/2024-canada-services-benefits-data/

Canada has long prided itself on its social programs, meant to reduce poverty and equalize access to what are seen as core rights like health care, education, food and shelter. It spends hundreds of billions of dollars a year on social safety supports that are a major reason millions of people want to move to the northern nation.

But key parts of its safety net are fraying — in some cases badly. In 2013, Canada ranked 13th out of 170 countries in meeting the basic needs of citizens, according to data tracked by Social Progress Imperative. By 2023, it had fallen to 39th, in large part because of a lack of affordable housing.

“Looking back 50 years ago, Canada had a relatively robust social safety net,” reads a 2023 report from Food Banks Canada on rising food insecurity. But spending cuts in the 1980s and 1990s, along with a move to put more responsibility for economic and social well-being on the shoulders of individuals, caused low-income Canadians to fall further behind, the report says. “Today, we are left with a social safety net that is filled with holes and that allows millions of people in Canada to fall through it.”

Meanwhile, more and more people are coming.

Canada’s Population Is Growing Faster Than Rest of G-7 or China

100 = Population in 2000

Source: World Bank

Canada is growing faster than any other Group of Seven nation, China or India, thanks to welcoming immigration policies intended to be a solution to falling birth rates. As longtime residents and newcomers alike struggle to meet their basic needs, there are growing worries about nascent anti-immigration sentiment.

Serious global headwinds — including years of elevated inflation and a spreading opioid crisis — are also gaining strength, in some cases exacerbated by other factors that make the country unique: its long undefended border with the US and its low population density, which can drive up federal government costs to deliver basic needs.

A Sparse Country

Canada has the fewest people per square mile out of all G-7 countries

Source: World Bank

The net result runs counter to the country’s longstanding vision of itself as a rich nation with a robust system of social supports that celebrates diversity and has historically relied on immigration as a pillar of economic growth. Although prone to exaggeration, it’s an ideal that has, nonetheless, long been part of Canada’s international brand, especially in comparisons with the US.

In global terms, Canada still stacks up well. And its decentralized system of government means no one entity is to blame for its failings. Katherine Cuplinskas, press secretary for Finance Minister Chrystia Freeland, called the notion that the country’s safety net is faltering “outrageous.”

“Whether or not you support the [Prime Minister Justin] Trudeau government, what is not up for debate is that this federal government has massively expanded and enhanced the social safety net,” she said in a statement, citing a drop in the poverty rate from 14.5%, when the Conservative Party was last in power in Ottawa, to 7.4%, with 2.3 million Canadians lifted out of poverty.

Even so, unaffordable housing, years-long waits for a doctor, food insecurity and a drug epidemic have reached crisis levels in Canada's four largest cities.

The stakes are high for Canada: If the country can adapt its safety net, it should be able to deliver on its promises to bring in people with the skill sets the country needs — from medical workers to homebuilders — and expand its tax base.

Traversing the country exposes the fault lines on the ground.

toronto skyline

Housing Crisis: Toronto

​Aarushi Thakur, a social work student, pays C$650 ($480) a month in cash for a bed in the shared basement of a house in the Toronto suburb of Brampton.

It’s the third place she’s stayed since coming to Canada a year ago. The second saw her crammed into a basement in a house with 15 other residents.

She’s one of more than 1 million international students in Canada as of the end of 2023, a group that has tripled in the last decade and, until recently, had no cap. More than half those new arrivals end up in Ontario, mostly around Toronto, one of the most diverse cities in the world — but increasingly short on homes.

Canada Has Seen a Rapid Rise in Foreign Students

The number of international students tripled in just over a decade

Source: Immigration, Refugees and Citizenship Canada

International students can pay five times as much for school, including multiple semesters upfront, and arrive unprepared for the reality of Canada’s housing market.

Before she left India, Thakur considered studying in the UK, Australia and the US but says she chose Canada because it seemed to offer the best long-term prospects for success. Although grateful for the opportunities that do exist, she says she wishes she’d chosen differently, and housing is a big part of why.

Aarushi Thakur portrait

Aarushi Thakur, an international student, at the Sai Dham Food Bank outside the City of Toronto, where she volunteers. David Dominguez/Bloomberg Originals

“My friends are calling, and they’re crying: ‘Is this the way a human lives?’ Excuse me, they’re living like animals.”

Toronto is at the epicenter of the country’s housing crisis, where scarce supply, coupled with a population boom, have led to a massive runup in prices. Canada’s largest city is also the country’s financial center — home to billionaire grocers, the country’s wealthiest bankers and celebrities including Drake — making the contrast between haves and have-nots particularly stark.

In the past decade, the number of people sleeping in emergency shelters in the City of Toronto has more than doubled to more than 9,000 people a night in 2023. Those numbers don’t capture those who are sleeping rough, in parks or on city streets.

Need for Shelter Beds Far Exceeds the Supply in Toronto

Source: Toronto Shelter & Support Services

“There are simply not enough beds for the amount of people who need them,” says Mark Aston, executive director of Covenant House Toronto, which shelters homeless youth. This winter, staff were forced to cram 45 emergency cots into the gym to supplement its 96 permanent beds, and it still wasn’t enough. “We’re running out of floor space to put up new cots.”

In 2023, the number of rental units considered affordable to families with the lowest incomes was statistically zero in Vancouver, Ottawa and Toronto, according to a recent report by Canada’s national housing agency. An adult working 40 hours a week for minimum wage earns roughly C$30,000, before taxes. Last year the average annual rent for a two-bedroom purpose-built apartment in Toronto — assuming you could find one — was C$23,280. To rent a similarly sized condo cost an average of C$34,344.

As for buying a home, that’s become increasingly out of reach for all but the wealthiest city residents as the average cost — including for condos — was more than C$1 million last year.

Housing Is More Expensive, Harder to Find

Note: Rent growth in 2023 measured for 2-bedroom units in privately initiated apartment structures of three or more units common to both the 2022 and 2023 surveys Source: Canada Mortgage and Housing Corporation

If you include temporary foreign workers and international students, the country added almost 1.3 million new residents in 2023, accounting for about 98% of its population growth.

As an emergency measure, Canada recently capped the number of new international student permits at about 360,000 for 2024, a policy that’s expected to have a marked effect on Toronto. Last week the government also set a goal to cut the number of temporary residents by about 20%, or 500,000, over three years, a direct response to the housing crisis.

Read More: Canada’s ‘Student Trafficking’ Industry is Backfiring on Trudeau

Canada’s largest city is home to billionaires, bankers and celebrities. It’s also the epicenter of the country’s housing crisis. David Dominguez/Bloomberg Originals

Meanwhile, the government is providing funds for asylum seekers — a group included in the temporary resident tally — that has suffered from the lack of shelter, and is launching initiatives across the country to build new and affordable housing. “We are turbocharging housing construction to bring down rent and mortgage costs,” Cuplinskas said.

But decades of underinvestment, coupled with real estate commoditization — house flipping has become almost a national sport in Canada — will take years to fix.

Still, there is some precedent for a turnaround. Canada invested massively in public housing after WWII and, until the late 1980s, was still managing to build about 18,000 units of deeply subsidized housing, says Stephen Gaetz, director of the Homeless Hub at Toronto’s York University. So far, efforts to add new units have focused on the middle class and have been nowhere near enough to reverse the shortage. “Maybe that kind of crisis opens up the possibility for change.”

“We’re well beyond the time where we can tinker with small policy changes,” says Aston. “There isn’t enough housing and people can’t afford food.”

toronto skyline

Food Insecurity: Calgary

Even in Calgary, in the heartland of a resource-blessed province with Canada's highest average incomes, a rising number of residents are relying on food banks to meet their needs. Home to a famous stampede, this boom-and-bust oil city is also the center of a conservative backlash against the federal government, fed by a growing sense that its policies are failing regular people.

The Calgary Food Bank served more than 33,000 people in December, a 40% increase from a year earlier.

Cost of Food Has Shot Up Across G-7 Nations

Annual rate of growth in food prices

Note: Data for EU is not available Source: OECD consumer price index

“You walk into the grocery store here, and by the time you step out, you’ve spent C$100 or more,” said Fred Dun-Dery, a post-doctoral researcher in infectious-disease control at the University of Calgary. “And then you walk home and you think, ‘Did I lose the money? Did I drop the money somewhere?’ Because two days later, you need to go back because what you bought is completely insufficient.”

Despite Canada’s expansive safety net, food banks — including the Calgary Food Bank — don’t typically rely on government funding as they’re meant to be emergency measures that kick in when the social safety net is strained.

“Not receiving the government money allows us to have an honest conversation with elected officials about policies which are causing food insecurity,” said Neil Hetherington, chief executive of the Daily Bread Food Bank in Toronto.

A customer shops for meat at a grocery store in Toronto.

When grocery prices rise, families often substitute cheaper ingredients but even ground beef prices are soaring in Canada. For many, food banks are the next stop. Photographer: Cole Burston/Bloomberg

Volunteers organize and prepare groceries for families and individuals in need at the Calgary Food Bank.

Volunteers organize and prepare groceries for families and individuals in need at the Calgary Food Bank. Photographer: Todd Korol/Bloomberg

He says programs meant to bolster income like pensions, disability benefits and guaranteed income supplements should ensure that people can cover their basic expenses. But government income supports haven’t always kept up with rising costs.

Housing costs, too, are a growing concern in Alberta, where rents are rising faster than anywhere else in Canada and housing demand is high.

Dun-Dery estimates that about half of his roughly C$40,000 to C$45,000 annual salary goes to pay for the family’s rented townhome near the university, leaving little room for much beyond the necessities.

One month late last year, school fees put him over the limit so much that Dun-Dery decided to turn to the Calgary Food Bank for temporary support.

Visits to Food Banks Are Up Across the Country

Percentage change in total visits, 2022–2023

Source: Food Banks Canada

“We saw that as a bridge to overcome the difficulty we were experiencing in that moment,” Dun-Dery said.

The government has taken some steps to respond to the need: A one-time “grocery rebate” in Canada’s 2023 budget adds food support to its income supplements for eligible Canadians. Cuplinskas cites other efforts to bolster resources, including increased benefits under the Canada Pension Plan, investment in job creation and the Canada Child Benefit program, which gives income support to eligible families with children.

Despite the challenges, Dun-Dery prefers the country’s social atmosphere to Germany, where he received his doctorate degree, and has been surprised by the kindness and generosity of neighbors in helping his family adjust to life here.

“The financial difficulties we experienced at the beginning, we are still not out of it yet — let’s be very cautious about that,” he said. “But I just feel that it’s something that is temporal. Eventually we should be able to overcome that.”

skyline

Health Care Holes: Montréal

When the global pandemic hit, health care systems around the world grappled to keep up with the inflow of sick patients. In Canada, where doctors were already under severe strain, the backlog that accumulated during this period today seems insurmountable, eroding the promise of universal and free access to health care.

The system, which is largely managed by provincial governments, is good at keeping residents out of medical debt and allowing people across classes and incomes to get quality care — once they can get to see a doctor. But it’s badly stretched.

In overcrowded emergency rooms, patients can wait more than 24 hours to be treated. There are even reported cases of people dying without ever seeing a doctor.

Waiting lists to have a medical consultation or have a surgery now stretch over months, if not years. Operating rooms must often shut down for lack of personnel. And doctors are wearing duct-taped ribbons to protest the state of the patchy health care system.

Increased Wait Times for Medical Treatment

Median number of weeks elapsed between GP consultation, referral to a specialist and treatment across nine medical specialties in Québec

Source: Fraser Institute

Canada’s physician-to-population ratio ranks 26th out of 31 high-income nations, just ahead of the US, according to the Organisation for Economic Co-operation and Development.

In Montréal, the country’s second-largest city, a shortage of general practitioners is the country’s worst: More than 36% of residents there don’t have one, driving up the average for the surrounding province of Québec.

With generous federal transfer payments and a heavy tax burden, the French-speaking province has a reputation for a strong safety net. And yet it has the longest wait time for a family doctor.

Québec Has Highest Share of People Without Primary Care

Note: No data available for territories, excluding Prince Edward Island Source: Statistics Canada, 2023

As frontline physicians, general practitioners are essential for the kind of early preventive care and diagnosis that avoids more serious health problems and emergency visits later. They are also the gatekeepers for access to specialists.

“You have a lot of diabetics or hypertensives who don’t know they are,” said Mark Roper, who’s been a GP for the last 35 years and treats 1,500 patients. “This has created a health care crisis in Montréal that people aren’t aware of.”

A lack of preventive appointments has knock-on effects across the whole health care system, burning out workers such as nurses who end up quitting. Next, the staff shortage shuts down operating rooms. It's a vicious circle.

“We know that for every 100,000 population, without a good continuity of care with a family doctor and his team of professionals, approximately 40 people die every year,” said Roper, citing a 1999 study. Roper also leads the division of primary care at the McGill University Health Center and the clinic Queen Elizabeth Family Medicine Group.

Across Canada, over 17,000 patients died while waiting for surgery or diagnostic scans in 2022-23, and roughly one in eight Canadians is confirmed to be waiting for surgery, a diagnostic scan, or to see a specialist, according to estimates from SecondStreet.org, a conservative think tank that's pushing for disruption in the public health sector. That’s almost certainly an underestimate due to insufficient data, according to the think tank.

In overcrowded emergency rooms in Montréal, patients can wait more than 24 hours to be seen. David Dominguez/Bloomberg Originals

Aside from the pandemic, a confluence of circumstances has led to the system’s decline: The delayed consequences of budget cuts in the ‘90s that reduced investment in medical training, restrictions in recruitment, an aging population with more complex needs and record immigration.

Québec’s health ministry recognizes the problem, and says it is "pursuing its efforts to improve access to front-line care" with a number of solutions, including better management of the work organization and the implementation of specialized nurse practitioner clinics.

Other potential policy ideas range from increasing the number of medical school seats and boosting incentives for students seeking a family physician career, to reducing the paperwork.

The Canadian government touts new investments of over C$200 billion in new funding in health care, as well as new national dental care and pharmacare.

In the meantime, private clinics are becoming more popular, draining medical workers from the public system and potentially making things worse.

A portrait of Dr. Mark Roper.

Mark Roper has been a family doctor for 35 years and has witnessed Canada's socialized medical system come under increasing strain. David Dominguez/Bloomberg Originals

Even for critics like Roper, rethinking the public system is not a consideration. Despite its challenges, the single-payer system has succeeded in allowing doctors to focus on the best treatment, without concern for cost or staggering medical bills.

For the very urgent cases like coronary stents, the system is excellent, said Roper. “But for the semi-urgent sort of painful hips, it’s a long wait time.”

toronto skyline

Drug Overdoses: Vancouver

Famous for evoking a healthy, relaxed outdoor lifestyle with skiing, organic food, and perhaps a bit of pot, Canada’s third-largest city is now also the poster child for a growing opioid crisis — which is compounded amid long-time housing and health care pressures.

More than six people die a day in British Columbia from toxic drug use. That’s double the rate of 2016, when the province declared its first-ever public health emergency, following a surge in deaths related to fentanyl, an opioid 50 times stronger than heroin.

Opioid Epidemic Is Deadliest in British Columbia

Note: 2022 is the latest full year of data available for opioid deaths Sources: Federal, provincial and territorial Special Advisory Committee on the Epidemic of Opioid Overdoses, Coroners Service of British Columbia

Unregulated toxic drugs are British Columbia’s leading cause of death for people between the ages of 10 and 59, exceeding “homicides, suicides, accidents, and natural disease combined,” according to a March report from the province’s Auditor General. The death toll is so profound it has reduced the province’s male life expectancy.

That’s pushed politicians to try radical policies.

Vancouver opened North America’s first legal supervised consumption site back in 2003, but declaring the 2016 emergency unlocked the ability to quickly open more sites and overdose prevention centers. Last year, British Columbia went further and decriminalized small amounts of hard drugs.

Health care and preventative care tents line East Hastings street in Vancouver's downtown east side.

Naxolone kits hang from the Overdose Prevention Society's tent on East Hastings street in Vancouver's downtown east side.

Naloxone kits are readily available at overdose prevention sites in Vancouver. Photographer: Jennifer Gauthier/Bloomberg

A spokesperson for the BC Ministry of Mental Health and Addictions said the policy’s aim is to destigmatize, so that people don’t fall into the criminal justice system and they feel comfortable seeking help. Arrests have plummeted, and hundreds more people have received treatment and recovery services.

But deaths haven’t markedly fallen. With people in public distress across the province, a debate is raging around the approach.

A group of British Columbia businesses is urging politicians to do more, citing street crime. And those questioning BC’s tactics — including Pierre Poilievre, national opposition Conservative leader — are getting louder as elections approach.

The province has moved to restrict where people can take drugs in public, pending a court challenge, while a similar experiment with decriminalization in Oregon was scrapped altogether in March amid rising deaths.

"The health care system is overrun. There's just not enough beds for people," says Matt Rosteski of his experience with addiction treatment in Vancouver.

"The health care system is overrun. There's just not enough beds for people," says Matt Rosteski of his experience with addiction treatment in Vancouver. Photographer: Jennifer Gauthier/Bloomberg

Decriminalization alone is ineffective unless it’s part of a wider system that hits the underlying causes and long-term effects of the fentanyl epidemic, says David Nutt, professor of neuropsychopharmacology at Imperial College London.

“Decriminalizing people who are using without changing their use doesn't get rid of the problem, obviously — because they keep taking it and they don't know what they're getting,” said Nutt. “They're going to die.”

Vancouver resident Matt Rosteski, who has lived experience with substance-use disorder and now works supporting others in recovery, said: “When you get out of treatment, the support is just gone, and then people fall off and just have to go through it again. So it's just perpetuating the cycle rather than following it through.”

There are calls for additional “harm reduction’’ measures to keep people alive in the short term. A panel convened by the chief coroner recommended expanding access to controlled drugs to save them from unpredictable street substances. But ultimately, it said, more comprehensive improvements are needed. That includes more services, shorter waiting times, and stable housing.

“We have a worsening homelessness problem here, and 70% of the people who are homeless have a substance-use problem,’’ said Mark Lysyshyn, Vancouver Coastal Health’s deputy chief medical health officer. “If you want to stabilize people on addiction treatment, but they don't have a home, how do you do that?’’