Prosperity and poverty make for uneasy bedfellows in world’s most ‘liveable’ city

by Patricia Leidl, UN Population Fund

Used syringes, garbage and clothing litter the floor of Sarah’s 10 by 10 ft room. Pockmarks, scabs and the scars from years of hard living mar the features of the still-pretty 26-year-old French Canadian. A long, sad-eyed man she introduces as her “room-mate” unfolds his gaunt frame from the narrow cot and runs nicotine stained-fingers through yellowing hair before quietly decamping. Outreach worker Dino Hurst has stopped by to check up on Sarah and to exchange more than 250 used “rigs” (syringes and needles) for clean ones.

For Hurst, a long-time employee with the Downtown Youth Activities Society (DEYAS), this room, the squalor and the unpredictability of his “clients”—whose behaviour can swing between touching gratitude one minute and angry invective the next—are just part of a day’s work in one of North America’s most blighted and drug-infested neighbourhoods. For Sarah, the life she now leads as an addict and occasional sex worker is thousands of kilometres and a lifetime away from her rural Quebec roots.

Both individuals—the outreach worker and the young addict—inhabit a world of violence and desperation that is literally steps away from some of the most expensive and coveted real estate in North America.

Encircled by mountains and flanked by glittering ocean, this city of more than 2 million has much to be proud of. The Economist Intelligence Unit deemed Vancouver among the three “most liveable” cities in the world for four years running (it ranked number one in 2005), while, in 2006, Conde-Nast Traveler‘s Reader’s Choice Survey dubbed Vancouver “top” city in the Americas. Lauded for its progressive city planning and dedication to sustainability, it is indeed a “city of the future”. In recent years, the metropolis has enjoyed a boom unprecedented in its 121-year history. Building construction—mostly skyscrapers filled with condos that easily sell for US$600,000 a unit—is at an all-time high, while office vacancy rates have dipped to near zero.

With the 2010 Olympics just around the corner, soaring real estate prices, a sizzling economy and a location so breathtakingly gorgeous that it continues to draw sightseers from around the world, Vancouverites are feeling bullish—and understandably so.

But there is trouble in paradise. And nowhere is it more evident than in the Downtown Eastside—a two-kilometre-square stretch of decaying rooming houses, seedy strip bars and shady pawnshops. Worst of all, it is home to a Hepatitis C (HCV) rate of just below 70 per cent and an HIV prevalence rate of an estimated 30 per cent—the same as Botswana’s.

But Vancouver’s Downtown Eastside is not as anomalous as it first appears: a poor neighbourhood contained within the embrace of wealth. As the 2007 State of World Population report: Unleashing the Potential of Urban Growth points out, this is the kind of price that a city—any city—will pay if it fails to support, plan for or house an expanding population of the urban poor. What makes the Downtown Eastside so different is that it is located in one of the most prosperous cities in one of the world’s most prosperous countries.

“There is a denial in this society that these people have chosen this lifestyle,” says acclaimed HIV/AIDS clinical specialist with the British Columbia Centre for Excellence in HIV/AIDS (BCCfE), Dr. Julio Montaner. “Unless we change this thinking, it will be very difficult to deal with this problem.” At the heart of the issue, he claims, is the fact that most of those living in the Downtown Eastside are impoverished, mentally ill, drug addicted and unable to obtain safe
and secure housing.

Since the 1980s, when many countries’ governments jumped on the “de-institutionalization” bandwagon, the Downtown Eastside has increasingly become the neighbourhood of choice for former habitués of government-run facilities. This is because it once offered a plethora of cheap SROs (single room occupancies) and the ready availability of street drugs. The rationale behind de-institutionalization was that most residents would be more humanely dealt with in monitored community housing. This never materialized.

Today, the Downtown Eastside is home to an estimated 10,000 people—many of whom are homeless, drug or alcohol addicted and/or mentally ill. The majority of residents supplement their miserable existence by scavenging for recyclables, stealing or selling their bodies for drugs and/or food. Those who are lucky enough to find accommodation, tend to live in SROs—many of which are owned and operated by the very gangs that sell drugs. Sarah’s hotel, considered by outreach workers to be one of the better ones, has eight tiny cubicles per floor and eight people and often more to share one small bathroom.

The City of Vancouver’s Homelessness Action Plan found that the number of indigent doubled between 2001 and 2004. The study also revealed that while only 15 per cent of the homeless were not receiving welfare in 2001, that number had soared to 75 per cent by the summer of 2004. Another study undertaken by the Pivot Legal Society, found that homelessness will likely triple by the 2010 Olympics.

The chief problem lies with living conditions that make it virtually impossible for individuals to access services. “We know what to do and how to do it,” says Montaner. “Thirty to 40 per cent of people who should be on treatment aren’t. Many are mentally ill and have other handicaps that make it impossible to prioritize treatment—they need secure housing and a secure food supply. In Canada, treatment is available for everyone who needs it—but you have to come and get it.”

City of Vancouver Mayor Sam Sullivan is among those who are worried. He agrees with the contention that Vancouver’s prosperity is bringing with it huge social and health costs, but believes that the City is finally coming to grips with the reality of the Downtown Eastside. “Drug addiction is not a technical problem,” he says. “If it were we would have solved it long ago. It is a political problem and requires that we negotiate a political solution.”

Lisa exemplifies the very vulnerability that Sullivan and his staff of planning experts speak of. Her chances of staying “clean”? “Zero,” says DEYAS intake worker Yvette Tanguay. “You can’t stay clean if “home” is an unsafe hotel room, a shelter or the street. You can’t stay clean under those conditions if you are mentally ill or disabled. It is simply not possible.”

Tanguay is nevertheless herself an example of exactly what is possible if both de-tox facilities and housing are made available at the very moment that addicts decide they want to kick their habit. Ten years ago, the petite and pretty 40-year-old was a survival sex worker hooked on both crack and heroin. Like Lisa, an abusive childhood and the violence and insecurity that she confronted every day on the streets had left her traumatized and looking for a way out. Unlike Lisa, however, Tanguay had the mental resources to get herself clean, but could not do so without help. One day, she found herself standing in the rain on a corner of Main Street in the Downtown Eastside. “I just wanted to die,” she says. “I’d gone 10 to 12 days without food and was out there on the street, not sleeping because I had nowhere to sleep”.

On that day, Tanguay made a decision: She called the DEYAS hotline and was able to get a de-tox bed straight away. With the help of a social worker who remains a close friend, Tanguay found secure housing and got herself “stabilized”. She has dedicated her life to helping those who, like her, face almost insurmountable odds in their fight to kick their addictions and leave the violence and insecurity of life on the street. Today, she owns her home and is finishing a master’s degree.

“I know what these people are going through because I was there,” she says. “A safe place to sleep: That shouldn’t be asking too much. Once you’ve got that, anything is possible.”