“I’ve seen unhoused patients lose limbs”: Physician Andrew Boozary on opening the country’s first social medicine housing
Dunn House, which opened in Parkdale earlier this month, provides residents with both affordable housing and on-site health care
Toronto is in the grip of both a homelessness and a health care crisis. Shelters are regularly filled to capacity and often have to turn people away. At the same time, hospitals are overwhelmed, with average ER wait times ranging from nearly 10 hours at Humber River to almost 26 hours at Sunnybrook. And the two phenomena feed into each other—at University Health Network (UHN), the organization that owns many of Toronto’s hospitals, 100 unhoused patients accounted for more than 4,500 emergency department visits in a single year. In response, UHN opened Dunn House, Canada’s first social medicine housing project, at 90 Dunn Avenue earlier this month. The modular housing complex will provide permanent, affordable accommodations and wrap-around health care services to 51 of UHN’s most medically complex and socially marginalized patients, many of whom have been unhoused or precariously housed.
Here, Andrew Boozary, executive director of UHN’s Gattuso Centre for Social Medicine, discusses how this new model works, his response to the neighbourhood’s safety concerns, and how projects like this could help solve Canada’s housing and health care crises.
Your background is in primary care. Why did you get into medicine? I grew up in social housing in St. James Town. As a child, I noticed the stark contrast between my neighbourhood and affluent areas like Rosedale. From my concrete balcony, the only outdoor space I had, I could see the vast green lawns and tree-lined yards of homes just a few hundred metres away. It became clear to me, even back then, that access to green spaces wasn’t just about aesthetics. Those with more wealth had access to healthier environments while many in my community struggled with poor health due to the limitations of our surroundings.
Dunn House is being called the nation’s first social medicine housing. What is social medicine? Social medicine focuses on how structural factors like housing, poverty and access to food are far more powerful in driving health outcomes than what can be done in a clinical setting. It’s about connecting health care and social care, like income support and community engagement programs, to improve outcomes, especially for marginalized communities. For example, the homelessness crisis in Canada is a public health crisis—people without stable housing live 30 to 40 years less than the general population. Chronic homelessness leads to higher rates of illnesses like diabetes, cardiovascular disease and cancer, as well as mental illness. Discharging patients to the street, especially in harsh climates, is hazardous to their health. You can’t talk about universal health care without recognizing housing as a human right.
Can you give me an example of how you’ve seen this play out? Many of my unhoused patients with diabetes struggle to manage their condition. Without stable housing, it’s nearly impossible for them to store or consistently take insulin, leading to severe complications. On numerous occasions, I’ve even seen patients lose limbs to amputation. Communities across the city have been advocating for housing as a means to save lives for decades. Looking at UHN data from 2019/20, just 234 patients—most of them unhoused—accounted for more than 15,000 emergency department visits. Additionally, unhoused patients were costing the heath care system six to seven times more because their conditions worsened without stable housing. Dunn House was conceived to break that cycle.
How does that all work in practice? Traditional social housing focuses solely on providing affordable accommodations. At Dunn House, each resident will have a studio apartment with a private bathroom and kitchen—giving people their own space is essential because it provides stability, security and, most importantly, a sense of dignity. Residents can also access a community kitchen and dining area, with fresh produce and cultural cooking sessions provided by FoodShare Toronto. The building also has a communal area for group activities and social programming such as book clubs and income tax clinics. Social workers are available on-site to help connect residents with health care and social supports. And then there’s access to free on-site health care: nurse practitioners, primary care providers, psychiatrists and virtual ER services provided through UHN. How did you decide who would get to live there? We used data to prioritize the UHN patients with the most health care needs. We looked at emergency room visits, hospital readmissions and total number of days spent in a hospital bed, combined with information about whether patients were actively unhoused. Then we reached out to individuals and extended invitations rather than taking applications.
Can you give an example of the kind of patient that got chosen? At UHN, we have an unhoused patient in their 20s who visited our emergency departments more than 200 times in the past year. This person had developed significant distrust toward health care practitioners because of broken promises of treatment and housing, along with being placed on wait lists with no clear end in sight. After months of effort by UHN’s peer support workers, we’ve earned that individual’s trust back, and they will be among the first to move into Dunn House.
Does Dunn House accommodate couples or families? Dunn House offers studio apartments, so it’s designed for single occupancy.
Can residents live at Dunn House indefinitely? Yes. There’s no looming discharge date—they can live there as long as they need. Residents receive leases with rent geared to income, generally around 30 per cent of their earnings. Typically, that means it’s starting from $400 to $500 per month. But it’s important to note that residents don’t need to be employed to live here. For individuals enrolled in Ontario Works or ODSP, their rent is calculated based on the monthly payments they receive. If they are employed or gain employment after moving in, their rent will be adjusted.
Doug Ford recently announced that supervised consumption sites within 200 metres of schools and daycares will be required to close next year, citing community concerns about drug use and potential violence. What would you say to Parkdale residents who have similar concerns about a project like Dunn House? The question is whether we believe some people are more deserving of life than others. Substance use happens across society—whether it’s cocaine in a condo or crack on the street. But are we willing to let people die simply because they’re unhoused? People who use drugs deserve the same dignity and safety as anyone else. There is also strong evidence that harm reduction and supportive housing make neighbourhoods healthier and safer by providing substance users with alternatives to places like parks and public bathrooms.
Does Dunn House restrict alcohol or drug use on-site? Residents are not required to be sober to live at Dunn House. However, Dunn House is also not a safe consumption site—it’s housing.
This all sounds like a massive undertaking. How did you make it happen? In terms of financing, the federal government contributed through its Rapid Housing Initiative, and the province and the city provided additional funding. UHN also leased the land—a parking lot—to the city for 49 years, at the cost of just $1. After a two-year design process, which involved partnerships with social service organizations and consultations with Parkdale community members and people who have experienced homelessness, construction began in 2022. Even though there were pandemic-related supply chain delays, Dunn House was completed within two years. People will start moving in over the next few weeks.
Do you think this model could be replicated across Canada? Absolutely. Dunn House demonstrates the power of leveraging underutilized public land like parking lots to address the housing and health care crises. Consider the economics: a hospital bed costs $30,000 per patient per month. Prisons—which in many ways are the de facto mental health care system for incarcerated Canadians—cost $10,300 per person per month. A shelter bed costs $6,000 per month. In contrast, supportive housing at Dunn House will cost $3,500 to $4,000 per month. That’s roughly one-tenth of the cost of a hospital bed. Even ignoring the benefits to residents’ personal dignity and quality of life, it’s simply more cost-effective than the alternatives.
Are you optimistic that the Dunn House model will be expanded? We have to maintain hope. Let’s be clear: this is about life and death. Our health care and housing systems are at a breaking point, and scaling models like Dunn House is critical for a more humane society. Partnerships between social service organizations and health care providers will be key, as will the financial and policy support of all three levels of government. We can’t continue with punitive policies that unjustly blame society’s most marginalized individuals for health outcomes when structural issues like housing are at fault. Expanding models rooted in human dignity is crucial for building communities that protect all their members. It’s far more hazardous and costly to stick to the status quo.
This interview has been edited for length and clarity.
Ali Amad is a Palestinian-Canadian journalist based in Toronto. His work has appeared in publications including Toronto Life, Maclean’s, Vice, Reader’s Digest and the Walrus, often exploring themes of identity, social justice and the immigrant experience.
