Social Sustainability, It takes a Village
Distributed Social Services
Chris Jalkotzy, City Villages
Unfortunately, governments are currently only operating in a reactionary mode when it comes to planning for our future health care needs. The problems we are and will be facing in Ontario include the following:
People over 65 now represent 16.7 percent of the population in Ontario and it is growing at roughly double the rate of the general population (3.4% vs 1.6% for the general population).
“While Canadians age 65 and older account for about 16% of the Canadian population, they use almost 46% of all public-sector health care dollars spent by provinces and territories. However, seniors are a diverse group. In 2014 (the latest available year for data broken down by age group), per-person spending for seniors increased with age: $6,424 for those age 65 to 69, $8,379 for those 70 to 74, $11,488 for those 75 to 79, and $21,150 for those 80 and older.”
The elderly have the best health outcomes if they are allowed to stay in their home and are kept socially connected.
“"Adults want to remain healthy and independent during their senior years, but traditional long-term care often diminishes seniors' independence and quality of life," said Marilyn Rantz, professor in the Sinclair School of Nursing. "Aging in Place enables most older adults to remain in the same environment and receive supportive health services as needed. With this type of care, most people wouldn't need to relocate to nursing homes."
“Older adults who are socially connected or perceive high levels of support and companionship from others have a nearly 70 percent chance of reporting very good or excellent health (see Figure 1). However, those who report extreme social disconnectedness or perceived isolation have only a 40 percent chance of reporting very good or excellent health.”
“1. More than anything else, homeless people need stable residences. The health problems of homeless people that differ from those of other poor people are directly related to their homeless state. Homelessness is a risk factor that predisposes people to a variety of health problems and complicates treatment. The committee considers that decent housing is not only socially desirable but is necessary for the prevention of disease and the promotion of health. Yet the number of housing units for people with low incomes has been steadily decreasing since 1981, while the number of people needing such housing has been increasing during that same period.”
Summary, The Solution
The “holy grail” for all categories of social services is full integration into the fabric of our urban communities. As a heuristic it may not always be fully achievable, but it is still important to try to aspire to it. The inner-city residential suburban areas in North American cities have many characteristics that make them ideal for the form of integration that will be described here.
Many non-gentrified Inner City residential suburban areas have the following characteristics:
Declining population due to aging families, older healthy occupants staying in their homes both as couples and as singles
Older small homes built in the 1950’s, 60’s and 70’s on relatively large lots with a relatively low housing density.
Access to some transit depending on location
Reasonable access to groceries and other staples
If we take into consideration
the demographics of our aging population and their relative health at 65 to 80 years of age,
potential health outcomes based on conflicting living circumstances (isolation vs remaining in one’s current home) and their desire to stay in their home.
current general approach to warehousing social and physical problem population demographics with its attendant stigmatization (e.g. Salvation Army),
The need to have high levels of supervision in programs like the “Housing First” initiative,
The significantly better health outcome for people with both mental and physical challenges if they are able to live safely in a “normal” urban environment,
The need to reverse the trend of depopulating the inner city residential suburbs without radically changing their characteristics,
The desire of the current population that is having children to live in the inner city residential suburb with a yard,
In european cities desirable characteristics already exist because:
Older Europeans have grown up in a dense urban residential suburb,
There is a stronger community sense of extended family that includes unrelated families
Stronger social connections
We would add the following to our inner city residential neighbourhoods:
In each “few” block area (100 to 200 population) a new multipurpose building of between 1,600 to 3,600 sqft building would be added. This building would be located on the undesirable lots (close to busy roads, difficult terrain, etc) would be added, The building would have the following characteristics:
Space for social and other caregivers to be able to operate from, storage space etc
Space for some “homebased” business type of activity
Min 3 to a maximum of 7 residential units.
Hydroponic/aeroponic green house for year around operation
Most open area would have a community garden
There would be a 3-season ground floor terrace for meetings and gatherings
The homes in the area would be offered the opportunity to have a secondary unit or coach house added to their dwelling.
The homes in the area would be offered to have a vegetable garden placed on their lot that could be maintained or the home owner would have assistance from the neighbourhood
The function of these elements is as follows:
 Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2016. Ottawa, ON: CIHI; 2016.,
 University of Missouri-Columbia. "Aging in place preserves seniors' independence, reduces care costs, researchers find." ScienceDaily. ScienceDaily, 7 March 2011. <www.sciencedaily.com/releases/2011/03/110307124816.htm>.
 CORNWELL, ERIN YORK, and LINDA J. WAITE. “Social Disconnectedness, Perceived Isolation, and Health among Older Adults.” Journal of health and social behavior 50.1 (2009): 31–48. Print.
 Institute of Medicine (US) Committee on Health Care for Homeless People. Homelessness, Health, and Human Needs. Washington (DC): National Academies Press (US); 1988. 6, Summary and Recommendations. Available from: https://www.ncbi.nlm.nih.gov/books/NBK218243/