Medicalization of Vancouver's Downtown Eastside

From UBC Wiki

The Medicalization of Vancouver's Downtown Eastside (DTES) is one of the ways in which the neighbourhood community is framed and understood.[1] Medicalization refers to the process in which someone or something is labelled as a medical issue, implying that it should be addressed through a medical intervention. At both the individual and social levels, framing affects how the framed subject is perceived.[2] There are both positive and negative implications in the medicalization of the DTES neighbourhood in Vancouver. While the DTES may benefit from positive public health interventions that address health-related concerns, the intersection between medicalization with other social factors may also have negative implications for the community.

Vancouver's Downtown Eastside (DTES)

Geographical boundaries of Vancouver's DTES

The Downtown Eastside is one of the oldest neighbourhoods in Vancouver, British Columbia, and is often characterized as facing several social issues such as substance use, crime, homelessness, and poverty.[3] Geographically, the DTES spans from Victory Square (in the west) to the Strathcona neighbourhood (in the east) and includes areas such as Gastown and Chinatown.

Demographics

According to the City of Vancouver, many groups in the DTES face higher risks compared to the general Canadian population.[3] Such risks include those relating to health, financial status, addiction, housing, etc. as many individuals living in the DTES are from vulnerable sub-populations. Examples of vulnerable sub-populations include individuals of Indigenous ancestry, women (especially those who work as sex trade workers), low-income individuals, and members of various other socially marginalized groups.[4] In particular, Indigenous people are over-represented in the DTES by five times their proportion of Vancouver's population.[4]

Current Issues

Many individuals in the DTES community are of low-income status and rely on monthly social assistance from the government.[5] This leads to the community's housing crisis, where it becomes difficult for individuals to obtain suitable housing.[6]

Substance use is prevalent in the DTES, ranging from consumption of alcohol to smoking and/or injecting illicit drugs (e.g. heroin, crack cocaine, methamphetamines, etc.). With high rates of substance use in the DTES, the community faces major public health risks, such as drug-related overdoses and the spread of infectious diseases (e.g. Hepatitis C and HIV co-infections). As of 2019, Vancouver's DTES is in the midst of the ongoing opioid epidemic, with growing exposure to fentanyl among people who use drugs, which can lead to fatal overdoses.[7] In April of 2016, British Columbia's health officials declared a public health emergency due to the alarming rise in drug-related deaths and overdoses.[8]

Crime is associated with the prevalence of substance use in the DTES.[6] There are reported cases in which individuals, predominantly women, rely on sex trade work to support their habits of substance-use, opening up the possibility for related harms.[9][10] Furthermore, the criminalization of illicit substance-use places many illicit substance users at risk of being charged for crime, which is also associated with their increased likelihood of engaging in unsafe activities to avoid the attention of legal authorities.[11]

Medicalization of the DTES

There are several different frames that assess the current state of Vancouver's DTES from various perspectives. These include medicalization, criminalization, and socialization, where the social issues that the community faces are a result of medical, criminal, and social problems respectively.[1] There are implications in the medicalized framing of Vancouver's DTES.

Common use of crack cocaine in the DTES

Medicalization: Framing the DTES as a Public Health Crisis

Vancouver's DTES community is framed as experiencing an ongoing public health crisis. For example, the community is declared to be in a public health emergency and part of the opioid crisis.[7][8] The media contributes to the framing of Vancouver's DTES to perpetuate and reinforce the notion that the social issues in the DTES stem from those that are health-related and medical.[1]

With the medicalization of the DTES, there is also the sentiment that the social issues must be addressed by targeting the health-related issues (both physical and mental) that the community faces.[1] These notions are apparent in the policy recommendations and public health interventions that advocate for the amelioration of health status for individuals and groups within the community.

Response to Medicalization

With the medicalization of Vancouver's DTES, the interventions that address the social issues focus on improving the overall health of the community.

The prevalence of substance use and associated harms calls for interventions that seek to reduce harm, addressing the physical risks that are associated with substance use. A notable example of harm reduction in the DTES is Insite, which was the first legalized supervised injection facility (SIF) in North America. Insite focuses on harm reduction to provide a safe and controlled environment, where individuals can use substances to minimize associated risks.[12] Since Insite was founded in 2003, there has been zero deaths due to overdose, as well as a decrease in overdose deaths by 35% in the area.[13]

Similarly, there have also been advocacy for policies that address mental health issues in the DTES.[6][14]

Positive Outcomes

Medicalization of the DTES specifically results in medical and health-related responses to the community. As medical attention and resources are invested into the DTES, members of the community reap the benefits as long as they can access the services that are made available to them. While accessing these services remain a barrier for many in the community,[15] the attention that people in the DTES receive as a result of its medicalization can be beneficial.

Negative Outcomes

While medicalization of the DTES may produce accessible health services, leading to improved health outcomes for the general DTES population, there are also negative implications.

Intersectionality

As of 2013, Indigenous people represent 10% of the population in the DTES, whereas they only comprise 2% of Vancouver's general population.[4] Medicalization of the DTES becomes problematic through an intersectional perspective, where the cultural needs of Indigenous populations in the DTES are not met through general health care interventions.[16] As broader health interventions misalign with the cultural values of Indigenous groups, arguments suggest that public health initiatives are a form of colonial oppression and are problematic for Indigenous sub-populations in the DTES.[17] In the midst of the medicalization of the DTES, there are calls for health services that are culturally safe and appropriate for Indigenous groups, and especially accommodate for the needs of women and youth.[18]

In addition to the Indigenous population, members of the LGBTQ community are specifically vulnerable in the DTES.[4] Members of this community are at higher risk of contracting HCV-HIV and are vulnerable to other health risks.[19] Yet, focus on this particularly vulnerable community is lacking in the midst of the medicalization of Vancouver's DTES.[19][20]

While medicalization seeks to improve health outcomes among the general DTES population,[1] an intersectional perspective reveals that there are vulnerable population whose values are not necessarily aligned with those of general health service providers, which may result in further stigmatization and marginalization of these sub-populations.[16][17][18][19][20]

Social Implications

The framing effect of the neighbourhood as a medical problem also poses a threat to the general DTES, as it labels the community as a problematic space, further stigmatizing the community.[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Liu, Sikee; Blomley, Nicholas (2013). "Making news and making space: Framing Vancouver's Downtown Eastside". The Canadian Geographer/Le Géographe Canadien. 57.2: 119–132.
  2. ↑ Kahneman, Daniel; Tversky, Amos (1984). "Choices, values, and frames". American Psychologist. 39(4): 341–350.
  3. ↑ 3.0 3.1 "Downtown Eastside". City of Vancouver.
  4. ↑ 4.0 4.1 4.2 4.3 "Downtown Eastside Local Area Profile 2013" (PDF).
  5. ↑ Riddell, Chris; Riddell, Rosemarie (2006). "Welfare checks, drug consumption, and health evidence from Vancouver injection drug users" (PDF). Journal of Human Resources. 41(1): 138–161.
  6. ↑ 6.0 6.1 6.2 Linden, Isabelle; Mar, Marissa; Werker, Gregory; Jang, Kerry; Krausz, Michael (2013). "Research on a vulnerable neighborhood—the Vancouver Downtown Eastside from 2001 to 2011" (PDF). Journal of Urban Health. 90(3): 559–573.
  7. ↑ 7.0 7.1 Hayashi, Kanna; Milloy, M.-J.; Lysyshyn, Mark; DeBeck, Kora; Nosova, Ekaterina; Wood, Evan; Kerr, Thomas (2018). "Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: a cross-sectional urine toxicology screening study". Drug and alcohol dependence. 183: 1–6.
  8. ↑ 8.0 8.1 "Public health emergency in BC".
  9. ↑ Shannon, Kate; Bright, Vicki; Gibson, Kate; Tyndall, Mark (2007). "Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada" (PDF). Canadian Journal of Public Health. 98(6): 465–469.
  10. ↑ Du Mont, Janice; McGregor, Margaret (2004). "Sexual assault in the lives of urban sex workers: A descriptive and comparative analysis". Women & Health. 39(3): 79–96.
  11. ↑ Small, Will; Rhodes, Tim; Wood, Evan; Kerr, Thomas (2007). "Public injection settings in Vancouver: Physical environment,social context and risk". International Journal of Drug Policy. 18(1): 27–36.
  12. ↑ "Insite - Supervised Consumption Site".
  13. ↑ "The science is in. And Insite works".
  14. ↑ Boyd, Jade; Kerr, Thomas (2016). "Policing 'Vancouver's mental health crisis': a critical discourse analysis". Critical public health. 26(4): 418–433.
  15. ↑ Small, Will; Van Borek, Natasha; Fairbairn, Nadia; Wood, Evan; Kerr, Thomas (2009). "Access to health and social services for IDU: the impact of a medically supervised injection facility". Drug and alcohol review. 28(4): 341–346.
  16. ↑ 16.0 16.1 Hare, Jan (2004). "Aboriginal women and healthcare" (PDF). Friends of women and children in BC Report Card. 3(12).
  17. ↑ 17.0 17.1 Carney, Lesley (2018). "The colonial dynamics of health care: An ethnographic study in Vancouver's Downtown Eastside". SFU Doctoral dissertation, Arts & Social Sciences: Department of Sociology and Anthropology.
  18. ↑ 18.0 18.1 Place, Jessica (2013). The health of Aboriginal people residing in urban areas. National Collaborating Centre for Aboriginal Health. p. 23.
  19. ↑ 19.0 19.1 19.2 Fast, Danya; Shoveller, Jean; Shannon, Kate; Kerr, Thomas (2010). "Safety and danger in downtown Vancouver: Understandings of place among young people entrenched in an urban drug scene". Health & place. 16(1): 51–60.
  20. ↑ 20.0 20.1 Marshall, Brandon; Kerr, Thomas; Shoveller, Jean; Montaner, Julio; Wood, Evan (2009). "Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth". BMC Public Health. 9:7: 1–9.
Retrieved from "https://wiki.ubc.ca/index.php?title=Medicalization_of_Vancouver%27s_Downtown_Eastside&oldid=561853"