Housing and the Mental Well-Being of Inuit Adults: Comparison
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Please note this is a comparison between Version 2 by Vivi Li and Version 1 by Karine Perreault.

Inuit regions in the Canadian Arctic, collectively known as Inuit Nunangat, are experiencing a persistent and growing housing crisis which has been characterized as “one of the most significant public health emergencies in Canada”. This study, conducted in pNartnership with Nunavut and Nunavik-based organizations, aims to provide a deeper understanding of the ways in which investments in affordabletional and regional health surveys have reported significant associations between poor housing construction operate to promotequality, household overcrowding and mental wellness indistress among Inuit regions.

  • housing construction
  • social housing
  • rehousing intervention
  • Indigenous
  • Inuit
  • mental health
  • health promotion
  • social determinant of health
  • Nunavut

1. Introduction

Inuit regions in the Canadian Arctic, collectively known as Inuit Nunangat (Figure 1, https://www.itk.ca/inuit-nunangat-map/ (accessed on 20 May 2022)), are experiencing a persistent and growing housing crisis which has been characterized as “one of the most significant public health emergencies in Canada” [1]. Indeed, important housing gaps between Inuit and non-Indigenous groups contribute to the social inequalities in health observed between these two groups in Canada [2]. In 2016, 40% of Inuit were considered in core housing need, based on housing adequacy, suitability (crowding), affordability, and availability standards (Appendix A), compared to 10% of non-Indigenous Canadians [3]. National and regional health surveys have reported significant associations between poor housing quality, household overcrowding and mental distress among Inuit [4,5,6][4][5][6]. However, the lived experiences of such housing conditions and their implications for mental well-being have rarely been explored from an Inuit perspective, with few exceptions [7,8,9][7][8][9] and never in the context of a housing intervention. Between 2015 and 2018, over 300 public housing units were constructed in Nunavut [10[10][11][12],11,12], one of the four Inuit regions in Canada. To put this figure into perspective, in 2009–2010, it was estimated that 3580 new dwellings were required to house people living in substandard housing (in need of major repairs and/or overcrowded) in Nunavut and who would move out if more housing were available in their community. Far from reaching the population’s housing needs ([13], p. 26), these newly built units nevertheless provided the opportunity for several Inuit families to be rehoused and improved their housing circumstances [14].
This aentrticley aims to explore the ways in which Inuit adults living in Nunavut who had been rehoused, and Inuit who applied to the waitlist for public housing and were still living in substandard conditions, perceived the rehousing intervention to affect, or to potentially affect, their mental well-being. The study was conducted in a remote and isolated community of Nunavut, the northernmost Canadian territory located above the 60th parallel, where none of the 25 communities have road access.
Figure 1.
Map of Inuit Nunangat.

2. Housing, Mental Well-Being, and Ontological Security

Although the links between poor housing quality, overcrowding, and poor physical health outcomes have been demonstrated [15], there is a knowledge gap when it comes to understanding the impacts of housing on mental health [16], and even more so regarding the health impacts of subjective housing experiences [17]. To respond to this gap, wresearchers turned to the ontological security theory [18] as it provides theoretical and empirical starting points to reflect on how housing shapes health, particularly mental health.
Stated simply, ontological security is a sense of confidence and trust in the world as it appears to be [19]. It is a security of being, derived from the confidence that most human beings have in the continuity of their self-identity and in the constancy of their social and material environments [19]. In Gidden’s view, the capacity to trust is necessary for emotional and psychological well-being for all individuals in all societies [18,20][18][20]. The realities from which ontological security is acquired and maintained are certainly culturally specific, but Giddens asserts that no human can function normally without ontological security. WResearchers return later to the relevance of using this theory in relation to the Inuit conception of mental well-being, and in the context of a rehousing intervention in the Inuit homeland.
The notion of ontological security has been developed specifically in relation to the home environment, in that “home is where people feel in control of their environment, free from surveillance, free to be themselves and at ease, in the deepest psychological sense, in a world that might at times be experienced as threatening and uncontrollable” [21]. More specifically, Dupuis and Thorns (1998) showed that the home can be a source of ontological security when the following four conditions are met: (i) home is the site of consistency in the social and material environment; (ii) home is a spatial context in which the day-to-day routines of human existence are performed; (iii) home is a site where people feel most in control of their lives because they feel free from the surveillance that is part of the contemporary world; (iv) home is a secure base around which identities are constructed.
In the last two decades, the notion of ontological security has been used to explain important functions of the home and their impacts on individuals’ health and well-being. The argument put forward, in essence, is that the home can serve as a medium for mental health promotion, when it provides a secure and stable tenancy (constancy), along with living conditions that promote individuals’ agency (autonomy and control) [17,23,24,25,26,27,28][17][22][23][24][25][26][27]. Home also relates to ontological security and well-being when experienced as a place of social connections and affection, which in turn support positive identity construction [23,24,25,27][22][23][24][26].
It must be acknowledged that housing scholars have been criticized for largely ignoring the negative impacts of housing on ontological (in)security [29][28]. One way to overcome these limitations is to carefully consider the wider context in which home has developed its significance as a source of ontological security, and to explore how the interactions with the context can potentially hamper the anticipated benefits or trigger unexpected effects. The geographic, economic, and historical contexts in which people evolve are understood socially in the creation of a place and form the foundation of local culture [30][29]. Kearns et al. (2000) argue that lived experiences of the home are heavily influenced by what has been termed “local cultures of home living”—the way in which housing is locally consumed and inhabited in its residential context.

3. The Housing Context in Inuit Nunangat and Its Impact on Mental Well-Being

Inuit have inhabited the Arctic regions of Canada and circumpolar countries for at least 5000 years [31][30]. They used to be nomadic, living in dwellings that were meant to be temporary—tents, igloos, qarmaqs (sod homes)—moving across a landscape they knew well to ensure their survival. In Northern Canada, colonization intensified between 1950 and 1960, when the federal government forcibly relocated Inuit into permanent communities where they lived year-round [32,33,34][31][32][33]. The first housing policy in the Canadian Arctic was implemented in 1959, an era that consolidated the shift from nomadic to sedentary lifestyles, and from subsistence to wage economy [35][34]. This period coincides with the establishment of the residential schooling system, which is widely recognized to be an institutional practice of “cultural oppression and forced assimilation” of Indigenous Peoples in Canada ([36][35], p. S16). In the North, residential schools took the form of day schools and small hostels, where children were separated from their families to attend ([37][36], p. 4). The intent of these schools was to indoctrinate Inuit children into the dominant Euro-Christian Canadian culture and prevent the transmission of cultural values and identity from one generation to the next ([38][37], p. 1).
Despite the evolution of housing policies and housing designs, to this day, Inuit housing needs have never been met [1]. Many challenges regarding sustainable housing delivery across Inuit Nunangat persist, including high living and housing costs, a short construction season, and reliance on funding from federal and provincial governments, which does not keep up with the ever-growing housing needs [39][38]. The resultant housing shortage leads to hidden homelessness and to household overcrowding, since the population has little option but to crowd into available housing stock [40][39]. In 2016, census data reported that 56.4% of the Nunavut’s population lived in overcrowding, compared to 8.5% of non-Indigenous Canadians [41][40]. In addition, more than 70% of the communities in Inuit Nunangat do not currently have a safe shelter for women and children experiencing family violence, and where they do exist, they are over-burdened [42][41]. In two cross-sectional studies conducted in Inuit regions, overcrowding has been associated with increased stress [43][42] and poor psychosocial health outcomes [44][43], particularly among women. Baseline data from a rehousing intervention conducted in Nunavut and Nunavik between 2014 and 2017 showed that household overcrowding was associated with a lower sense of home among Inuit adults [45][44]. The sense of home scale used in thise study echoes the notion of “ontological security from the home” in that it assessed people’s perceptions of their home in relation to constructs such as control, privacy, relationships, identity, and safety [45][44]. Pre- and post-rehousing data of the same intervention research indicated that the reduction in the number of adults per household, and more specifically a transition to nuclear family arrangements (two adults or less with children), were significant predictors of psychological distress reduction [46][45]. The increase in the sense of home was also a significant contributor to psychological distress improvements. In contrast, longitudinal analyses from other studies conducted in Inuit regions have shown inconclusive results regarding the association between crowding and mental health outcomes [47,48][46][47].

4. Mental Well-Being from an Inuit Perspective

Until recently, the majority of research on mental health among Inuit has used scales or questionnaires developed for, and adapted from, non-Indigenous populations. Grasping the essence of what it means to “be well” across cultures is a challenging endeavour given that every culture has distinct notions of what it is to be a socially valued and well-functioning human being [49][48]. The Alianait Inuit-Specific Mental Wellness Task Group defines well-being as “self-esteem and personal dignity flowing from the presence of a harmonious physical, emotional, mental and spiritual wellness and cultural identity” [50][49].
In contrast to the emphasis on individuality in much of Western society, the idea of a healthy person in the traditional Inuit culture gives a central role to connections among individuals and to place, a vision that has been called ‘ecocentric’ (as opposed to egocentric) [49,51][48][50]. According to Kirmayer (2009), the identity of an Inuk person develops through constant transactions with his or her environment, which includes other human beings, animals, and the land. It follows that healing processes involve, by definition, practices aiming at (re)connecting the people together and with the land, in a way that is comforting, supportive, and productive [51][50]. One central theme in the literature exploring resilience and mental health from an Inuit perspective is family: spending time with family, talking, sharing food, going out on the land together [49,51,52][48][50][51]. Another central theme in relation to mental wellness is the practice of traditional activities as a means to reconnect with Inuit culture and identity [36,51,53,54,55,56][35][50][52][53][54][55]. Examples of Inuit traditional practices that are meaningful and conducive to well-being include going out on the land, harvesting country food, camping, or arts and craft occupations such as carving and sewing [52][51]. It must be emphasized that these practices cannot be separated from the family, since traditional skills are learned and enjoyed with family members.
A recent review of the literature on Inuit wellness identified that research to date has largely been disease-oriented and often emphasizes stigmatizing comparisons between Indigenous and non-Indigenous people. Thus, research that could lead to ways of understanding mental health promotion from an Inuit perspective is needed [57][56]. In this respect, interventions with positive impacts on family relationships and cultural identity are viewed as more likely to produce benefits, since they address central features of Inuit well-being [36,57,58][35][56][57]. The ontological security theory, as articulated by Dupuis and Thorns (1998) and Kearns et al. (2000), aligns with the Inuit conceptualization of well-being in that it places social relationships and self-identity as foundational processes through which the experiences of home influence health and well-being. It also considers housing functions that intersect with human rights that are considered essential for a healthy development, including the right to access and sustain a safe and stable home [59][58].
To ouresearchers' knowledge, no research to date has explored Inuit lived experiences of a rehousing intervention. Such knowledge could contribute to “opening the black box” of housing intervention mechanisms to better understand how rehousing leads to mental health benefits, and what circumstances favor or restrain such benefits [60][59]. Finally, an Inuit-informed understanding of the links between rehousing and mental well-being could be of relevance to territorial and other Inuit organizations who advocate on behalf of Inuit housing and health rights (Section 4.2).

5. Methods and participants5. Methods and Participants

In total, 25 participants took part in semi-structured interviews. The first part of the interview focused on participants’ experience of their current housing circumstances, or in comparison to prior housing conditions for participants who were rehoused. The second part explored perceived impacts on mental well-being more specifically. Links with mental well-being were examined from an Inuit perspective, based on central features of Inuit well-being and happiness: family relationships and cultural practices [50,51,52][49][50][51]. Out of the 25 participants, 8 were men and 17 were women. Participants who were rehoused (n = 11; 4 men, 7 women) were in their twenties or early thirties, they all had children and were living in nuclear family arrangements (1–2 parents with children). Participants who were on the waiting list for social housing (n = 14; 4 men, 10 women) presented a broader age range, from early twenties to late fifties. They all had children and typically were living in multigenerational and overcrowded households, with their parents, siblings, children, and their siblings’ children, or a combination of these.

6. Findings and Conclusion

6. Findings and conclusion

Findings demonstrate that moving to a newly built public housing unit led to important changes in the ways that families experienced their home, which then shaped their well-being. Three main themes were identified to describe the ways in which subjective housing experiences improved the mental well-being of Inuit adults (and their families) after rehousing. Improvements in the material aspects of housing (e.g., physical space, available water, thermal comfort, salubrious conditions), provided the necessary conditions for participants to (1) offer comfort and refuge to their families, (2) to self-determine their lives, and to increase the control they had over their daily routines. These changes, in turn, (3) facilitated positive family dynamics and identity repair. The word “repair” implicitly evokes healing, which was achieved through routinized gestures conducive to social harmony and cultural identity, an aspect that is particularly relevant in the context of cultural oppression. However, it was evident that, despite the many mental well-being benefits that emerged from the intervention, rehousing did not resolve all the socioeconomic challenges that the Inuit are facing (for example poverty and food insecurity), and these challenges have co-occurring negative influences on mental well-being. According to Inuit representatives, in order to build sustainable housing in the North, the focus must shift towards recognizing Inuit self-determination and providing housing options that are culturally appropriate, among other things [13,104][13][60]. On the latter point, Inuit participants in this sentudy ry reported the need for safe shelters and transitional housing to protect and support the most vulnerable members of their communities. They also expressed the need for an increased number of affordable housing units that can accommodate various household sizes, including large families, so that more individuals, couples, and families can enjoy more positive interactions between household members, along with pursuing their life goals and cultural practices. Because these needs intersect with recognized fundamental human rights, weresearchers argue that construction initiatives increasing public housing stock and addressing gaps in the housing continuum are urgently needed. Such investments would bring Canada closer to meeting its commitment regarding Indigenous rights to adequate housing, enshrined in articles 21 and 23 of the UNDRIP Act [90][61]. Despite the enormous challenges that lie ahead, the Inuit-informed evidence presented in this aentrticley supports the health-promoting potential of sustainable housing delivery across Inuit Nunangat.

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