FASD has huge impact on homelessness

In terms of cost, FASD is the biggest public health issue in the province (by far).

FASD has huge impact on homelessness

Re: “Homelessness issues in Cowichan not going anywhere soon,” (Citizen, Nov. 1)

The cited column was appreciated. Reading such descriptions leads one to contemplate circumstances leading up to the Lewis Street raid, and the causes for homelessness. One wonders, also, about application of the adage “to turn off the tap as well as to mop the floor”. Provision of housing and other supports is important.

Interestingly, about a third of pregnancies in Canada are alcohol exposed, because of largely inadvertent alcohol consumption by women who do not realize that they are pregnant. Eighty per cent of people in Canada consume alcohol and 40 per cent of pregnancies are unplanned. This amounts to about 124,000 births annually. Of these about 10 per cent (three per cent of the whole population) manifest with Fetal Alcohol Spectrum Disorder (FASD), which is a condition of severe, permanent brain damage and attendant dysfunction and mental health issues that is also sometimes accompanied by subtle physical abnormalities and a myriad of physical health problems. Little is known about the other 90 per cent of alcohol exposed births, but one can reasonably assume that these unfortunate people are functioning sub par with learning, attention, sleep and other disabilities or special needs that may or may not be formally diagnosed or addressed.

Of the million or so people with FASD in Canada about 150,000 live in British Columbia, and more than 10,000 on the Island. Most are adults, and most have not accessed a formal diagnosis, in part because diagnostic and intervention services are inadequate, and in part, because of the condition itself, as brain damage may impair the executive function necessary to access care.

The province funds diagnosis for about 1,000 people a year so most will never access this under the best of conditions. A majority of these victims lead a dreadful life, sleeping rough in the open, experiencing violence and exploitation, poverty and poor nutrition and cycling through various shelters, health care services, enforcement, judicial and correctional services and various ancillary services such as addictions services, needle exchanges, soup kitchens, food banks and sometimes disability and income support services. Sixty per cent of those with FASD encounter the law, very often with recurrent incarceration due to repeat offending caused by brain damage, learning disability and judgement difficulty. Occasionally circumstances arise for rescue, formal diagnosis and intervention, which is largely mediated through services such as youth justice and CLBC. Research is emerging, but it is known that about 23 per cent to 35 per cent of all correctional centre inmates in Canada have FASD and it is thought that the figure for homeless shelters is of the order of 60 per cent, this one condition being a leading underlying cause of homelessness. FASD is the pre-eminent cause for congenital brain damage in Canada and the most common cause for severe mental health issues. It is unfortunate that our key 21st century approach to managing the most important causes for brain damage and mental ill health is with jail time. Bill C235 attempted to address this but was blocked by Canada’s collective justice ministers.

Notwithstanding this, the annual taxpayer cost of this dreadful life is expensive, at about $6 billion in B.C. alone, excluding the secondary loss to families and others. This amount is similar to the current health care cost of heart disease, stroke, cancer and diabetes added together, and is similar to that of traffic accidents which are also largely alcohol fueled. The cost of harm approaches the pretax revenue of the entire alcohol value chain, making this industry the most heavily subsidized in Canada.

Put further into perspective, the taxpayer cost of health care in B.C. is $21 billion. In terms of cost, FASD is the biggest public health issue in the province (by far). If readers are property owners in the Cowichan Valley, they may request a pie diagram of how their property taxes are spent, and except for a sliver of the pie which may apply to services relevant to their property, the rest of the pie supports the cited social services. No one is worried about this as that support is our civic duty. More is needed. This is what we are spending on mopping the floor. We are not turning off the tap. Whilst there are other causes for homelessness, if society aspires to achieve a long term reduction in homelessness, fetal alcohol spectrum disorder and alcohol exposed pregnancy will need to be addressed more effectively. Timely diagnosis and intervention in the form of educational supports, housing, income support and a myriad of other health supports, appears to reduce the cost of the condition by about 50 per cent at the same time as improving quality of life for the victims, but prevention is key.

FASD and its concomitant homelessness are eminently preventable. This being the most sensible approach in conjunction with provision of diagnosis, supports and services. The World Health Organization advocates a policy called SAFER, to help address this (www.who.int/substance_abuse/safer). In essence this involves, inter alia, regulating or banning alcohol advertising, increasing the price of alcohol through taxation to cost recovery levels (about $10-12 a unit), setting a minimum price regardless of outlet and disallowing discounts and specials including happy hours and ladies nights. It also includes stricter controls on availability.

With respect to preventing FASD, these measures would entail a preclusion of marketing premixed drinks and miniatures (at point of sale), these being specifically aimed at women of childbearing age. Education plays a limited role in the face of overwhelming advertising. Depending upon how stark it is, labelling may also be useful. All of this needs considerable engagement from the alcohol industry, which has been slow in coming forward.

Many countries have adopted these measures because of an epidemic of weekend binge drinking amongst young women in the OECD, causing severe ER congestion. Whilst FASD is more likely to occur in children born to mothers who drink heavily, binge drink or who have an alcohol use disorder, there appears to be no safe amount of alcohol which can be consumed in pregnancy, with severe brain damage effects seen in children whose mothers concede to only having had as little as a glass of wine at a wedding. If their male partners have an alcohol use disorder the occurrence and severity of fetal brain damage is higher. Whilst fetal brain damage can happen if alcohol is consumed at any time during pregnancy much of the damage happens before recognition of pregnancy, physical abnormalities happening before the first missed period, early in the formation of the face, brain and heart. This has led to a change in the public health advice which now advocates that “women at risk of being or becoming pregnant should not consume alcohol whether or not a pregnancy is planned”. Birth control fails in up to 18 per cent of sexual encounters so cannot be regarded as a failsafe method to prevent the occurrence of alcohol exposed pregnancy. Generally women who are pregnant or who are planning a pregnancy stop drinking so the advice is now relevant to those who are at risk of an unplanned pregnancy, and who may, albeit inadvertently, expose their pregnancy to alcohol.

Hopefully this will help us to gain perspective on the Lewis Street raid.

Neil Heard

Duncan

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