Overcrowding and Sense of Home in the Canadian Arctic

Housing Studies

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Overcrowding and sense of home in the Canadian Arctic

Karine Perreault, Mylène Riva, Philippe Dufresne & Christopher Fletcher

To cite this article: Karine Perreault, Mylène Riva, Philippe Dufresne & Christopher Fletcher (2019): Overcrowding and sense of home in the Canadian Arctic, Housing Studies, DOI: 10.1080/02673037.2019.1602720 To link to this article: https://doi.org/10.1080/02673037.2019.1602720

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Overcrowding and sense of home in the Canadian Arctic

Karine Perreaulta,Mylene Rivab,c, Philippe Dufresnec and Christopher Fletcherd aSchool of Public Health, Universite de Montreal, Montreal, Quebec, Canada; bCanada Research Chair in Housing, Community and Health, McGill University, Montreal, Quebec, Canada; cInstitute for Health and Social Policy and Department of Geography, McGill University, Montreal, Quebec, Canada; dDepartment of Social and Preventive Medicine, Universite Laval, Quebec city, Quebec, Canada

ABSTRACT ARTICLE HISTORY This study examines the relationship between living in Received 8 June 2018 overcrowded conditions and sense of home among 289 Inuit, the Accepted 11 March 2019 Indigenous population living in the Canadian Arctic. This study KEYWORDS was conducted in Nunavut and Nunavik, two of the four Inuit Indigenous Peoples; Inuit; regions in Canada, where the prevalence of overcrowding is six housing needs; times the national average. Sense of home was derived from the overcrowding; sense conceptual notion of ontological security, where home is defined of home; gender as a symbolic place for making claims of cultural identity and belonging. Sense of home was operationalized according to participants’ perception of their home in relation to space, identity, control, privacy, satisfaction, relationships, location, and security. Overcrowding was negatively associated with sense of home. In overcrowded dwellings, fewer women reported positive perceptions of their house with regards to sufficient space, feeling of identity, satisfaction and domestic relationships. Relational and cultural aspects of housing resonate with sense of home and may be particularly interesting to examine as potential mechanisms leading to individual and community wellbeing.

Introduction In Canada, Inuit are the Indigenous Peoples of the Arctic.1 They mostly live in four regions, Nunavut, Nunavik (northern Quebec), Nunatsiavut (Labrador) and Inuvialuit (Northwest Territories and Yukon), known collectively as Inuit Nunangat (Wallace, 2014), ‘the place where Inuit live’ (Figure 1). The relationship between Inuit and the State is organized through modern land-claims agreements in each region. Within Inuit Nunangat, 52% of the population lives in overcrowded housing, compared to 8.5% for Canada as a whole (Statistics Canada, 2017e). This housing crisis is a direct consequence of colonial settlement policies. Given the important social and health implications of overcrowding in Inuit regions (Knotsch & Kinnon, 2011), and the strong meanings attached to its colonial roots, overcrowding may connect to sense of

CONTACT Mylene Riva [email protected] Department of Geography, McGill University, Burnside Hall Building, Room 705, 805 Sherbrooke Street West, Montreal, QC, H3A 0B9, Canada Supplemental data for this article is available online at https://doi.org/10.1080/02673037.2019.1602720. ß 2019 Informa UK Limited, trading as Taylor & Francis Group 2 K. PERREAULT ET AL.

Figure 1. Map of Inuit Nunangat. Source: Inuit Tapiriit Kanatami. Available at https://www.itk.ca/ wp-content/uploads/2016/07/InuitNunaat_Basic_0.pdf home by refraining home-making (make oneself at home) practices. This article explores the relationship between overcrowding and sense of home in the Inuit regions of Nunavut and Nunavik.

Historical background Inuit were traditionally a nomadic people, following the seasonal migration of game and wildlife, living in summer tents called tupiit, and temporary snow houses (igluit) in winter. The 1920s, 1930s, and 1940s marked a shift in Inuit lifestyle as contacts with White people influenced Inuit to start developing settled communities and to work year-round (Tester, 2006, 2009). In the 1950s, the Canadian government intensified the settlement and relocation process of Inuit in order to shift economic activities away from traditional pursuits, from subsistence hunting to mining for example, in order to facilitate provision of supplies and services (e.g. medical, educa- tion) to these remote communities and to protect Canada’s sovereignty in the Arctic (Tester, 2006, 2009). With this came the need of permanent hamlets. The few houses built were unsuitable to the Arctic climate, and quickly became overcrowded, con- straining the Canadian government to develop housing policies for Inuit. In the following decades, despite government’s intervention, the Arctic witnessed more of the same: inadequacy of dwellings, demographic growth, and increasing but unmet housing needs. In 1993, the federal government announced that it was unilaterally ceasing to fund any new long-term social housing commitments in Canada, including in northern regions. This contributed to the housing crisis that Inuit communities are HOUSING STUDIES 3 experiencing today (Societed’habitation du Quebec, 2014; Tester, 2009). In reaction to the crisis, housing authorities were formed at the regional and territorial level with the mandate to create, coordinate and administer housing programs. Beginning in the 1940s, the population of Inuit Nunangat is now settled in 51 communities, on a territory that spans one third of Canada’s landmass (Inuit Tapiriit Kanatami, 2016a). The size of communities ranges between 100 inhabitants to about 7700 in Iqaluit the capital of Nunavut. Except for some communities in the Inuivialuit region, none of the communities have road access; they are only accessible by air or water. The remoteness of communities, along with other factors such as the short construction season, the high cost of importing construction materials and labour, the rapid increase of the population, and the complex intergovernmental coordination of housing provision are contributing to the housing shortage in the Canadian Arctic (Inuit Tapiriit Kanatami, 2016b; Knotsch & Kinnon, 2011; NCCAH, 2017). Budgetary compromises on the quality of building materials, coupled with the wear and tear brought on by overcrowding and the harsh Arctic climate, accelerate the deterioration of dwellings (Inuit Tapiriit Kanatami, 2016b). The 2013 Nunavik Housing Needs Survey concluded that 899 new housing units were required to meet housing needs in the region (Societed’habitation du Quebec, 2014). In 2009–2010 in Nunavut, 3780 residents (20% of those aged 15 years and older) were waiting for public housing. Of these, 1330 had been on the waitlist for one to three years, and 550 for five years or more (Nunavut Housing Corporation, 2011). Even though social housing policies at the federal, provincial or territorial levels have been implemented over the years, housing needs continue to increase. Of the 65,025 Inuit living in Canada at the 2016 Census, 46% live in Nunavut and 18% live in Nunavik (Statistics Canada, 2017a). The Inuit population in Canada is young: 33% are 14 years or younger, as compared to 17% for non-Indigenous population. The population is also rapidly growing; between 2006 and 2016, the Inuit population grew the fastest in Nunavik (þ23.3%) and Nunavut (þ22.5%) (Statistics Canada, 2017a) compared to 11.2% for Canada (Statistics Canada, 2017b). The young and rapidly growing population is one factor pressuring housing needs. In 2015, the median income for Inuit aged 15 years and over living in Inuit Nunangat was $23,485 CAD, compared with $34,204 for the general Canadian population (Statistics Canada, 2016), and with $92,011 for non-Indigenous residents of the region (Inuit Tapiriit Kanatami, 2018). According to Canada Mortgage and Housing Corporation (CMHC), the average costs for operating and maintaining a home, including heating, electricity, public services (water delivery, waste water and garbage collection), property taxes, and repair costs is around $25,000 per year in Nunavut, more than the median income (Senate Canada, Dyck et al., 2017). Northern housing construction costs are also higher than in Southern Canada. On average, construction in Nunavut costs three times more than in the Greater Toronto Area. In 2016, the construction cost of a new public housing unit was generally between $400,000 and $550,000 (Legislative Assembly of Nunavut, 2016), depending on the community. In Kuujjuaq, Nunavik, based on assessments conducted in 2008, it cost a household almost $345,000 to build a house of 98 m2, more than double 4 K. PERREAULT ET AL. the estimated cost for an equivalent house built in Quebec City (Societed’habitation du Quebec, 2014). Despite recent economic growth in Inuit Nunangat, most of the population have insufficient assets to afford high prices of commodities, and consequently have little option but to rely on subsidies and cost-of-living adjustment measures (Inuit Tapiriit Kanatami, 2016b). This situation limits the expansion of a private housing market, and provides insight into why over 80% of the population in Nunavik and Nunavut live in subsidized housing (Statistics Canada, 2017d). Rents are paid monthly and are proportionate to income and dwelling size.

Overcrowding in Inuit communities and impacts on health and psychosocial outcomes The historical and contemporary conditions of housing across the Canadian Arctic are often referred to as ‘acrisis’, which compromises the health of the population and community capacity for social and economic development (Knotsch & Kinnon, 2011; NCCAH, 2017). The 2016 census reports that 56% and 52% of the population in Nunavut and Nunavik respectively are living in houses considered overcrowded (defined at the 2016 Canadian Census as a house with at least a one bedroom shortfall), more than six times the national average (8.5%) (Statistics Canada, 2017e). Indigenous Peoples in Canada, including Inuit, live in larger families and are more likely to live in a multigeneration household than non-Indigenous Canadians (Turner & Statistics Canada, 2016). In 2011 in Inuit Nunangat, 14% of Inuit children aged 14 years and under were living in a multigeneration household, compared to 8% for non-Indigenous children of the same age (Turner & Statistics Canada, 2016). One important driver of such arrange- ment is the lack of housing, but other reasons include the importance of extended family, the strength of social support networks, and the common practice of customary child adoption (Milan et al., 2015; Pauktuutit Inuit Women of Canada, 2006). The social and health implications of living in overcrowded housing for Inuit are manifold and include, for example, increase of lower respiratory tract infections among children (Banerji et al., 2009), infections with tuberculosis for those living with someone with smear-positive TB (Khan et al., 2016) and increased food insecurity (Ruiz-Castell et al., 2015). Recent studies show that living in overcrowded conditions is associated with elevated chronic stress responses among adults in Nunavik (Riva et al., 2014b), and with poorer mental well-being among Inuit from Greenland (Riva et al., 2014a). In both of these studies, associations were stronger among women (Riva et al., 2014a, 2014b). It has been hypothesized that overcrowding affects men and women differently through processes such as perceived lack of control and increased emotional demand (Griffin et al., 2002; Regoeczi, 2008). This hypothesis aligns with results from the 2004 Nunavik Inuit Health Survey, where a higher proportion of women reported that someone made them worry or demanded too much from them, a factor that was associated with psychological distress (Kirmayer et al., 2007). Distinctions between men and women were also reported in the 2012 Aboriginal Peoples Survey in which inadequate housing conditions (poor HOUSING STUDIES 5 quality and overcrowding) were associated with mental distress among Inuit women, but not men (Wallace, 2014). A study conducted in Nunavut, discussing health and social implications of overcrowding in the region, situates overcrowding as the result of the forced settlement of Inuit communities, coupled with chronic underfunding in housing since the early 1960s when the first social housing policies were implemented in the North (Lauster & Tester, 2014). Overcrowding is then argued to be the driver of homelessness – being and feeling without a home – where ‘home’ is defined as a profound experience of connectedness and security. ‘Feeling at home’ includes elements such as belonging to a community, nurturing an intimate knowledge of one’s homeland, enjoying sufficient privacy and feeling secure (having a secure space to store one’spossession,freedom from danger, sense of stability over time) (Lauster & Tester, 2014). This echoes work exploring the identity-making process of Inuit living in southern Canadian cities, and how they make themselves feel at home within an urban environment which at first seems hostile to their way of life in their homeland (Neale, 2017; Pauktuutit Inuit Women of Canada, 2017). Home-making is framed as a process of cultural promotion through social interactions, where an identity is forged by the experience of cultural practices, such as speaking Inuktut, sharing food, visiting family. The social linkages that are formed in the city, connecting individuals to families, and families to a community, are the vehicle through which cultural and social values are transmitted, forging a sense of belonging and the experience of ‘feeling at home’ (Neale, 2017; Pauktuutit Inuit Women of Canada, 2017). Considering home as a symbolic stage for making claims to social belonging and cultural identity connects with the concept of ontological security provided by home, defined as a constant social and material environment that provides a safe place for identity development and self-actualization, where people can live out their daily routines and gain a sense of control, of mastery (Giddens, 1991). This ontological security, along with one’s satisfaction with housing, are important psychosocial factors (PSF) contributing to the sense of home (Kearns et al., 2000). The literature on place sees home as a particular type of place, and similarly provides insights into the meanings attached to ‘having a place called home’; those meanings are tied to people’s identities, attachment bonds, and psychological well-being (Easthope, 2004).

Sense of home as a psychosocial pathway linking housing to health Although attempts were made to conceptualize the etiological connections between health outcomes and housing conditions (Dunn, 2000), many studies do not explain the pathways through which housing conditions ‘get under the skin’ to influence health (Clark & Kearns, 2012). A growing literature suggests that housing conditions might influence health through psychosocial pathways, referring to ‘social-psychological’ mechanisms, or the influence and interaction of social factors on an individual’s psychological state of mind (Martikainen et al., 2002). These psychological processes may influence health through direct psychobiological mechanisms, or through modified behaviors and lifestyles (Richmond & Kulmann, 2011). 6 K. PERREAULT ET AL.

The psychosocial environment refers to the social context in which we live and nurture meaningful interactions, and how these interactions make us think, feel, and behave (Clark & Kearns, 2012). A health-promoting psychosocial environment is ‘one that promotes a positive experience or view of oneself in relation to others, for example in terms of trust, control, confidence, self-esteem and status, all of which can be considered as beneficial psychosocial factors (PSF) (Clark & Kearns, 2012). Kearns et al. (2000), in the specific context of home ownership, identified three central PSF linked to the home environment: refuge (security, retreat), status (pride), and autonomy (control). They also argued that home relations involve struggles of boundary maintenance, and that family life can sometimes be unpredictable and inva- sive of personal privacy and control. In a study conducted in one community in Nunavut, Tester (2006) found that overcrowding was linked to anger, arguments within families, and depressive symptoms. Participants believed that social problems would be alleviated to some extent if the problem of overcrowding was addressed. When asked about why they would need a different home, 71% of the respondents mentioned reasons related to design, which was not appropriate for practicing traditional activities and unsuitable to raise children. This notion of cultural suitability of homes was also raised by Dawson (2006), who demonstrated that the spatial organization of northern houses is not adapted to Inuit ways of living which impacts upon social interactions and family life. The form of a typical ‘Euro-Canadian’ house reflects the daily practices of Euro- Canadian families. It is designed based on Western values and the nuclear family model, where space is organized to provide privacy (e.g. individual bedrooms) and to facilitate the westernized expected roles of women and men, parents and children. All these factors stand in contrast to the extended family model, and mutual dependence relationships, that have defined social structures in Inuit societies (Debicka & Friedman, 2009; Tester, 2009). Dawson (2008) demonstrated that floor plans and commodities of Euro-Canadian houses are ill-suited to traditional cooking and meat preparation techniques, and the limited storage space does not accomodate cultural practices such as hunting, carving, and sewing. Social activities in Inuit households present a need for highly integrated spaces, open and connected, conducive of a sense of ‘togetherness’. These findings resonate with the notion of ontological security, which the home environment is supposed to provide, and its potential implications for health over the life course. There is evidence suggesting that rehousing (i.e. relocating to a different dwelling or to a dwelling that has seen improvement in indoor conditions) contributes to a sense of home, which in turn improves health. PSF contributing to sense of home could therefore be seen as components of the psychosocial pathway linking housing and health (Kearns et al., 2011). In Glasgow, Scotland, the SHARP study investigated changes in mental health among low-income families before and after they were rehoused in new social housing units. At 2-year follow-up, changes in material housing conditions had substantial impacts on PSF (gains in in space, privacy, and safety), which in turn affected mental health, as measured with SF-36 subscales (Kearns et al., 2011). The magnitude of the impact was different among household types, where families with dependent children (as opposed to adults only households) benefited HOUSING STUDIES 7 most from the relocation. This highlights that different people have different needs in relation to housing, and the extent to which these needs are met may affect the scope of health impacts of such intervention. There are few studies on housing conditions and PSF among Inuit, or among other Indigenous populations. Yet in the Inuit context, the relation between overcrowding and housing-related PSF might be especially relevant to examine given: (i) the high prevalence of household overcrowding in the Arctic (Statistics Canada, 2017e); (ii) the potential cross-cultural differences in tolerance for crowding (Evans et al., 2000), (iii) the suggested role of PSF linking household crowding and health (Thomson & Thomas, 2015), and (iv) the history of forced settlement and housing policies that have had an impact on the current housing provision and allocation processes (Tester, 2009).

Study objective This study examines the relationship between living in overcrowded conditions and several PSF capturing ‘sense of home’ in twelve Inuit communities in Nunavik and Nunavut. The specific objectives are to: (1) describe the differences in PSF between participants who live in overcrowded versus non-overcrowded dwellings; (2) examine sex differences in PSF between participants who live in overcrowded versus non-overcrowded dwellings; and (3) quantify the association between sense of home score (8-item PSF score) and overcrowding status, adjusting for individuals’ socioeconomic characteristics.

Methods The project Housing, health and well-being in the Arctic In 2014–2015, 216 public housing units were constructed in eight of 14 communities in Nunavik and 210 housing units in 12 of 25 communities in Nunavut. Construction included a mix of one-bedroom, two-bedroom, and four-bedroom dwellings, accommodating single-person households, and small and large family households. In collaboration with Inuit organizations responsible for housing, public health and for preserving Inuit values and practices, a before-and-after study was designed to assess the impacts of rehousing to a newly built or preexisting social housing unit on the health and well-being. Data analyzed in this article are those collected 1–6 months before rehousing. At the time data collection took place, participants did not know if they would be rehoused.

Study design and sample size This study has a cross-sectional design using data collected in the fall 2014 in Nunavik and in the spring 2015 in Nunavut. Data were collected in six communities in each region where new housing units were being built. In both regions, new housing units are first allocated to communities where the housing shortage is most acute. Units are then allocated locally to applicants most in need, where need is defined by a point-based system set according to specific criteria, for example low-income, 8 K. PERREAULT ET AL. dependent children, living in a health or security threatening environment (Kativik Municipal Housing Bureau, 2014; Nunavut Housing Corporation, 2015). Single-person or family households whose rank placed them in the top of the local waitlist for social housing (those who were most likely to move) were recruited by local housing managers (LHM). Households who apply to social housing usually already live in social housing (80% in our sample), most often with extended family members or in- laws. They apply to social housing in the hope of having a suitable and adequate place of their own. All adults (18 years) within households on the waitlist were invited to participate. A total of 134 adults from 117 households in Nunavik and 155 adults from 124 households in Nunavut answered the questionnaires, yielding a participation rate of 68%.

Ethical implications From the outset, the Housing, health and well-being in the Arctic study was developed according to an integrated knowledge translation approach (Canadian Institutes of Health Research (CIHR), 2015), in partnership with several regional and territorial organizations in Nunavut and Nunavik (see acknowledgments). Partner organizations contributed to developing the objectives and the design of the study, and critically reviewed and approved the present manuscript. Recruitment material produced by the research team was distributed by local housing managers in English, Inuktitut and Inuinnaqtun. Potential participants were informed that the study was conducted independently from housing organizations in their region, such that their participation to the study would not affect their rank on the waitlist, their housing situation, and whether or not they would be rehoused. Informed written consent was provided by participants following an explanation of the study. The project was approved and supported by mayors of the communities involved, the Nunavik Nutrition and Health Committee, and the Nunavut Research Institute (license #0201817R-M). It received ethical approval from the Comited’ethique de la recherche du CHU de Quebec and from McGill University Research Ethics Board.

Data collection A team of two research assistants trained in research methods and administration of questionnaires collected the data; they were supported by locally recruited Inuit researchers. Data collection took place in a neutral environment, usually in rented rooms in municipal buildings. Interviews were administered in the language of choice of the participant (English, French, Inuktitut or Inuinnaqtun with the help of the local researchers). The Household Questionnaire was used to collect information on structural housing conditions, including crowding, and was administered only to the main household respondent, that is the person whose name was on the waitlist. The Individual Questionnaire was answered by all participants and collected information on housing conditions, including psychosocial factors associated with the house environment, health, socioeconomic and cultural information. Several variables and items assessed in this study were adapted from surveys and studies conducted among Inuit HOUSING STUDIES 9 and Indigenous populations in Canada (Cloutier, 2012; Saudny et al., 2012; Rochette & Blanchet, 2007). The final version of the questionnaires was piloted in Nunavik prior to data collection. Each interview lasted about 75 minutes. Participants received a $20 gift card from the local store as compensation for their time, and their names were entered in a draw to win an i-pad.

Overcrowding Participants reported the number of persons permanently living in the dwelling (meaning they had nowhere else to live, and slept there most of the time) and the number of bedrooms in the dwelling, to which two additional rooms were added, for the kitchen and living room (Riva et al., 2014b). A ratio of the number of person to the numbers of rooms was created. Overcrowding was defined as more than one person per room (PPR) (Tait, 2008).

Sense of home Psychosocial factors (PSF) representing ‘sense of home’ were measured using 21 items enclosed in one of the eight following constructs: space (4 items), identity (3 items), control (3 items), privacy (2 items), satisfaction (2 items), relationships (2 items), location (3 items), and safety and residential stability (2 items). The items were formulated as ‘statements’; they were derived from previous studies (Dunn, 2002; Kearns et al., 2011) and adapted to the Inuit context. PSF were initially operationalized by Kearns et al. (2000) based on the theoretical concept of ‘ontological security from the home’ developed from previous work (Dupuis & Thorns, 1998; Giddens, 1991;Kearns,2000) and adapted for use in empirical studies (Clark & Kearns, 2012;Dunn,2002;Eganet al., 2010; Kearns et al., 2011). The cultural relevance of the constructs were first explored in qualitative interviews on housing experiences in Nunavik. Items associated with each construct were then adapted, reformulated and integrated in the overall survey. A continuous 8-item sense of home score (including only one item per construct) was computed from the initial 21 items (Supporting Information Table S1). For constructs composed of three or more items, Cronbach alpha tests were performed to determine the item that contributed the most to the construct. For constructs composed of only two items, selection of the item to be included was determined logically according to our evaluation of the formulation best reflecting the construct (e.g. ‘I have privacy’ was chosen for the construct of privacy). The Cronbach’s alpha coeffi- cient for the selected eight items is 0.76, which is considered satisfactory. Participants reported agreement with each item on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The 8-item sense of home score ranges from 8 to 40, with higher values indicating a stronger sense of home.

Covariates Sex, age, and household financial situation were used as covariates in the regression models since they were previously shown to be linked with psychosocial outcomes 10 K. PERREAULT ET AL.

(Riva et al., 2014a). In the household questionnaire, participants were asked to describe their household financial situation with the following possible answers: ‘We run out of money before payday’, ‘We are spending more money than we get’, ‘We have just enough money to get us through the next payday’, ‘There’s some money left over each week’, ‘We can save a bit every now and then’ and ‘We can save a lot’ (Mullan & Redmond, 2012). Answers were then grouped in three categories: ‘we spend more money than we get’, ‘we have just enough money’ and ‘we can save money’. These answers were attributed to all participants within the same household. Models were also adjusted for region, to account for the structure of the data.

Statistical analysis Descriptive statistics of the full sample are presented with frequencies and proportions, or means and standard errors (Table 1). The 21 PSF items were dichotomized and stratified by household overcrowding status, and by sex. Differences were tested using multilevel logistic regression models with participants nested within households, nested within communities. The models’ p values denote the statistical difference between participants living in overcrowded versus non-overcrowded dwellings (Table 2), or between men and women (Table 3). Association between the 8-item sense of home score and overcrowding, adjusting for individuals’ covariates was estimated using multilevel linear regression model with participants nested within households, nested within communities (Table 4). For all analyses, statistical significance is set at p < 0.05.

Results Descriptive statistics of the participants are presented in Table 1. Most participants (74%) were aged between 18 and 35 years old, and the gender distribution was almost equivalent (56% women). Over half of participants reported being in a relationship; 58% declared having enough money to get from payday to payday. A large proportion of participants were living in social housing (80%), and a majority of households were composed of three or more adults living with children (70%) (on average 6.5 residents per dwelling, or 1.2 person per room). The same proportion of participants (58%) were living in objectively measured overcrowded dwellings (>1 people per room) and perceived to be living in an overcrowded environment. Just over half of participants declared having lived in the current house for more than 5 years; 17% of them for their whole life. A third of the sample (35%) reported having moved two times or more in the last five years. Compared to participants living in overcrowded dwellings, participants living in non- overcrowded houses reported more favorable perception of PSF associated with the house for all items regarding constructs of space, identity, control, privacy, and satisfaction (Table 2). They also agreed in a higher proportion to one item of the relationship (gets along with people in the house, p ¼ 0.004) and location constructs. Items addressing safety and residential stability did not statistically vary by overcrowding status. In houses that were not overcrowded, perception of PSF did not differ between men and women (Table 3). In overcrowded dwellings, fewer women reported positive HOUSING STUDIES 11

Table 1. Demographic and housing characteristics of the 289 participants to the project Housing, health and well-being in the Arctic (baseline data collection, 2014–2015). (N (%)) Age 18–25 years 110 (38.1) 26–35 years 103 (35.6) 36–45 years 34 (11.8) 46 years 42 (14.5) Sex Men 126 (43.6) Women 163 (56.4) Words best describing household’s money situationa Spending more money than we get 98 (40.7) Have just enough money to the next pay day 78 (32.4) Can save a bit every now and then 61 (25.3) Relationship status Single 128 (44.3) In a relationship 159 (55.0) Time lived in house Less than a year 44 (15.2) 1 to 5 years 96 (33.2) 6 to 10 years 55 (19.0) More than 10 years 45 (15.6) All my life 48 (16.6) Current type of housea Social housing 188 (80.0) Other 48 (19.9) Frequency of residential moves last 5 years Did not move 149 (52.3) 1 time 36 (12.6) 2 times 39 (13.7) 3 times 27 (9.5) 4 times 10 (3.5) 5 times 24 (8.4) Frequency of residential moves last 5 years Mean (se)b 1.5 (0.2) a Number of residents, number of rooms Mean (se)b Total nb of people usually living in the house 6.5 (0.2) Number of children < 5 years old 1.1 (0.1) Number of children aged 5–17 years old 1.3 (0.1) Number of adults aged 18–59 years old 3.7 (0.1) Number of adults aged 60 years old 0.3 (0.0) Number of bedrooms 3.3 (0.1) Crowding and overcrowdinga Person per room Mean (se)b 1.2 (0.0) > 1 person per room 140 (58.1) Perceived crowding (n[%])c 139 (57.7) Adult/child ratio Mean (se)b 1.6 (0.1) Household compositiona Adult(s) only 41 (17.0) One adult with child(ren) 6 (2.5) 2 adults with child(ren) 25 (10.4) 3 adults with child(ren) 169 (70.1) a Data from the household questionnaire presented (N ¼ 141). Other data come from the individual questionnaire (N ¼ 289). b Standard error of the mean. c Household respondent who answered ‘yes’ to the question: ‘Do you think there are too many people living in your house?’ perceptions of their house environment on specific items in relation to space, identity, satisfaction, and relationships. For example, fewer women agreed or strongly agreed that their house is a good reflection of themselves (37% vs. 55% for men, 12 K. PERREAULT ET AL.

Table 2. Psychosocial dimensions of housing (21 PSF items) of 289 participants to the project Housing, health and well-being in the Arctic (baseline data collection, 2014–2015). Overcrowdingb (>1 person per room) Psychosocial factors: participants who agreed No (N (%)) Yes (N (%)) Constructs with the following statementsa 114 (40.0) 171 (60.0) p valuec Space Too many rooms in the housed 70 (61.4) 139 (81.3) 0.003 Rooms too smalld 49 (43.0) 44 (25.7) 0.015 Kitchen big enough to prepare and cook food 78 (68.4) 86 (50.3) 0.007 for your family Enough storage space 72 (63.2) 69 (40.4) 0.002 Identity House is a good reflection of oneself 76 (66.7) 76 (44.4) 0.002 Home provides a good place to live one’s life 72 (63.2) 79 (46.2) 0.030 Can do all the activities I want in the house 71 (62.3) 81 (47.4) 0.035 Control I can do what I want, when I want in the house 68 (59.6) 77 (45.0) 0.023 Can make changes in my house 56 (49.1) 57 (33.3) 0.037 Feels in control in the house 54 (47.4) 43 (25.1) 0.008 Privacy Have privacy 72 (63.2) 70 (40.9) 0.003 Can get away from it all in the house 70 (61.4) 77 (45.0) 0.038 Satisfaction Like living in the house 64 (56.1) 66 (38.6) 0.008 Satisfaction with the house 70 (61.4) 79 (46.2) 0.030 Relationships Gets along with people in the house 87 (76.3) 104 (60.8) 0.004 Can’t stand to be at home sometimesd 31 (27.2) 32 (18.7) 0.117 Location House well located to meet every day needs 88 (77.2) 115 (67.3) 0.031 Friends and family living nearby 89 (78.1) 135 (78.9) 0.713 View on nature from the house 76 (66.7) 118 (69.0) 0.652 Safety and Worry about having to move out of my housed 69 (60.5) 106 (62.0) 0.638 residential stability Feels safe in my house 89 (78.1) 125 (73.1) 0.459 Bold values indicate statistical significance at p < 0.05. aIncludes people who answered either agree or strongly agree, vs. those reporting neither agree or disagree, disagree, or strongly disagree. bParticipants living with a partner who answered the household questionnaire were attributed the same answer as their partner’s answer (e.g. someone living with a partner who answered the household questionnaire and declared living in an overcrowded dwelling is identified as such). cp value are obtained by running a multilevel logistic regression on each dichotomized PSFs while adjusting for overcrowding. The model’s p-value associated with overcrowding is reported and denotes a statistical difference between participants living in overcrowded or non-overcrowded dwellings when <0.05. dItems are reverse-coded; includes people who answered strongly disagree or disagree, vs. those reporting neither agree or disagree, agree, or strongly agree. p ¼ 0.038), with having enough storage space (32% vs. 52% for men, p ¼ 0.020), or with getting along with people in their house (51% vs. 75% for men, p ¼ 0.004). Results of linear regression models for the associations between the 8-item sense of home score and household overcrowding adjusted for covariates are shown in Table 4. Results from the fully-adjusted model indicate that participants who lived in overcrowded houses have a mean sense of home score 2.6 points lower than participants in non-overcrowded houses. Women also have a lower sense of home score compared to men by an average of 1.9 points. Participants reporting being able to save money had a greater mean sense of home score of 2.1 points when compared to those reporting spending more money than they get. Table 4 also presents results stratified by sex. While the association between overcrowding and sense of home was marginally significant in men (p ¼ 0.057), the fully adjusted model shows that women who lived in overcrowded dwellings had a mean sense of home score 2.9 points lower than women in non-overcrowded houses (p ¼ 0.005). Women who could save money had a greater mean sense of home score Table 3. Psychosocial dimensions of housing (21 PSF items) stratified by household overcrowding and sex of 289 participants to the project Housing, health and well-being in the Arctic (baseline data collection, 2014–2015). Overcrowding No (1 person per room) Yes (>1 person per room) Sex Sex Psychosocial factors: participants who agreed Men (N (%)) Women (N Men (N (%)) Women (N (%)) Constructs with the following statementsa 55 (47.4) (%)) 61 (52.6) p-valueb 69 (40.8) 100 (59.2) p-valueb Space Too many rooms in the housec 33 (60.0) 37 (62.7) 0.677 61 (88.4) 78 (76.5) 0.081 Rooms too smallc 24 (43.6) 25 (42.4) 0.999 22 (31.9) 22 (21.6) 0.174 Kitchen big enough to prepare and cook food 42 (76.4) 36 (61.0) 0.112 33 (47.8) 53 (52.0) 0.416 for your family Enough storage space 36 (65.5) 36 (61.0) 0.352 36 (52.2) 33 (32.4) 0.020 Identity House is a good reflection of oneself 37 (67.3) 39 (66.1) 0.630 38 (55.1) 38 (37.3) 0.038 Home provides a good place to live one’s life 40 (72.7) 32 (54.2) 0.074 41 (59.4) 38 (37.3) 0.020 Can do all the activities I want in the house 34 (61.8) 37 (62.7) 0.750 31 (44.9) 50 (49.0) 0.504 Control I can do what I want, when I want in the house 31 (56.4) 37 (62.7) 0.571 31 (44.9) 46 (45.1) 0.897 Can make changes in my house 23 (41.8) 33 (55.9) 0.157 28 (40.6) 29 (28.4) 0.115 Feels in control in the house 26 (47.3) 28 (47.5) 0.943 16 (23.2) 27 (26.5) 0.420 Privacy Have privacy 35 (63.6) 37 (62.7) 0.918 34 (49.3) 36 (35.3) 0.100 Can get away from it all in the house 34 (61.8) 36 (61.0) 0.843 28 (40.6) 49 (48.0) 0.260 Satisfaction Like living in the house 33 (60.0) 31 (52.5) 0.437 36 (52.2) 30 (29.4) 0.011 Satisfaction with the house 40 (72.7) 30 (50.8) 0.018 41 (59.4) 38 (37.3) 0.014 Relationships Gets along with people in the house 40 (72.7) 47 (79.7) 0.937 52 (75.4) 52 (51.0) 0.004 Can’t stand to be at home sometimesc 18 (32.7) 13 (22.0) 0.230 17 (24.6) 15 (14.7) 0.112 Location House well located to meet every day needs 42 (76.4) 46 (78.0) 0.981 50 (72.5) 65 (63.7) 0.268 Friends and family living nearby 42 (76.4) 47 (79.7) 0.625 58 (84.1) 77 (75.5) 0.259 View on nature from the house 41 (74.5) 35 (59.3) 0.119 51 (73.9) 67 (65.7) 0.256 Safety & Worry about having to move out of my housec 32 (58.2) 37 (62.7) 0.708 39 (56.5) 67 (65.7) 0.179

Residential Feels safe in my house 48 (87.3) 41 (69.5) 0.056 55 (79.7) 70 (68.6) 0.133 STUDIES HOUSING stability Bold values indicate statistical significance at p < 0.05. aIncludes people who answered either agree or strongly agree, vs. those reporting neither agree or disagree, disagree, or strongly disagree. bp-value are obtained by modeling each individual PSFs while adjusting for participants’ sex. The model’s p-value associated with sex is reported, and denotes a statistical difference between men and women when less than 0.05. cItems are reverse-coded; includes people who answered strongly disagree or disagree, vs. those reporting neither agree or disagree, agree, or strongly agree. 13 14 K. PERREAULT ET AL.

Table 4. Association between the 8-item sense of home score and household overcrowding for 289 participants to the project Housing, health and well-being in the Arctic (baseline data collection, 2014–2015), adjusted for selected covariates and stratified by sex. All participants Men Women b (SEa) p-value b (SEa) p-value b (SEa) p-value Overcrowding (>1 PPRb) 2.6 (0.7) <0.001 1.7 (0.9) 0.057 2.9 (1.0) 0.005 Age 0.03 (0.03) 0.364 0.03 (0.05) 0.537 0.06 (0.04) 0.154 Women 1.8 (0.6) 0.003 NA NA Nunavut 1.8 (0.6) 0.006 1.1 (1.0) 0.294 1.8 (0.9) 0.038 Household money situation We spend more money than we get Ref Ref Ref We get just enough money 1.4 (0.7) 0.055 1.5 (0.9) 0.119 0.9 (1.0) 0.390 We can save money 2.1 (0.8) 0.010 1.3 (1.1) 0.235 2.5 (1.0) 0.015 Intercept 26.2 (1.9) <0.001 27.0 (2.5) <0.001 21.7 (2.3) <0.001 Bold values indicate statistical significance at p < 0.05. aStandard error. bPerson per room. of 2.5 points when compared to women who spent more money than they get (p ¼ 0.015); this association was not observed in men.

Discussion The objective of this study was to assess whether living in an overcrowded dwelling was differently associated to house-related PSF, operationalized as people’s perception of psychosocial aspects of their house environment, among Inuit adults from Nunavut and Nunavik. The results show that space, identity, control, privacy, and satisfaction with the house are more favorably perceived among participants who are not living in overcrowded dwellings. Results are mixed regarding relationships within the house and location, and are nonsignificant for safety and residential stability. In non-overcrowded dwellings, all constructs were perceived similarly between men and women. The situation was different in overcrowded dwellings where, compared to men, fewer women tended to agree with positively phrased items related to space, identity, satisfaction with the house, and relationships with other household members. Regression results show a significant difference in the 8-item sense of home score between overcrowded and non-overcrowded houses, with participants having a lower sense of home score in overcrowded dwellings. When stratified by sex, the negative association between overcrowding and sense of home, and the positive association between money situation and sense of home, were only observed in women.

Overcrowding and sense of home Results of this study show that variation in sense of home is influenced by household crowding, and differs between men and women. Similar relationships have been reported in the literature, although exclusively in non-Indigenous contexts, and with a particular emphasis on crowding as a condition impacting social processes within the house (Evans et al., 2000; 2003; Fuller et al., 1996). The use of an objective measure of crowding among Inuit has been criticized. According to Lauster & Tester (2010), such measure corresponds to a westernized HOUSING STUDIES 15 notion of privacy that has contributed to ‘disciplining’ Inuit families into southern ways of living, and may not appropriately reflect the experience of overcrowding in the Inuit culture. However, these authors also acknowledge that, as a result of the rapid cultural shift imposed by colonization, Inuit youth have become accustomed with ideas such as the need of having one’s own bedroom, and may now relate to space in ways similar to Southerners. The results presented in this study show that one objective measure of overcrowding (>1 person per room) is negatively associated with perceived psychosocial aspects of the house, including privacy, control, identity, and satisfaction. Similar results were observed in different cultural contexts and parts of the world, suggesting that association between overcrowding and house-related PSF holds despite cross-cultural differences that may exist in the perceptions and experiences of crowding (Evans et al., 2000; Fuller et al., 1996; Lepore et al., 1991). Of note, the proportion of participants living in objectively and subjectively defined overcrowded dwellings were practically identical in this study (respectively 58.1% vs. 57.7%, Table 1).

Towards a better understanding of the pathways linking housing and health Our findings align with reviews having explored pathways linking housing conditions (including overcrowding) to health outcomes. Thomson et al.’s(2013) Cochrane review on housing interventions and health discussed quantitative and qualitative findings from 39 studies (Thomson et al., 2013). This comprehensive work led to the development of an empirically-based theory, which helps to explain how improved housing conditions may affect health (Thomson & Thomas, 2015). The intermediate mechanisms identified include several PSF similar to those explored in our study, and were mostly identified through qualitative studies. More specifically, evidence showed that ‘physical/structural’ improvements of the house (e.g. warmth, space, design, disposable income) were linked to PSF such as feelings of control over one’s living environment, housing satisfaction, increased feelings of privacy, increased availability of safe play areas for children, and improved domestic relationships (Bullen et al., 2008; Ellaway et al., 2000;Gibsonet al., 2011). These PSF were in turn described as having a positive impact on mental health and well-being (Bullen et al., 2008; Ellaway et al., 2000;Gibsonet al., 2011;Kearns et al., 2008). Although insufficient to unpack the ‘black box’ of mechanisms linking housing and health, our study provides quantified evidence of the relationship between overcrowding and house-related PSF. It offers support to the first part of the pathway theory suggested by Thomson et al. (Thomson & Thomas, 2015;Thomsonet al., 2013), linking a space density indicator to psychosocial outcomes, themselves representing ‘valuable proxy of the potential for longer term health impacts’.

Overcrowding and women’s well-being The difference between men and women in relation to overcrowding has also been reported elsewhere. Gabe and Williams observed that, compared to men, women had more symptoms related to psychological distress when living in overcrowded household (Gabe & Williams, 1986). A Canadian study compared depression, withdrawal, and 16 K. PERREAULT ET AL. aggression in men and women in overcrowded settings, and found that crowding stress causes men to respond with increased levels of aggression, while women responds to it with increased levels of depression (Regoeczi, 2008). These findings are consistent with results from two studies conducted in Inuit settings, where overcrowding was associated with increased stress markers (Riva et al., 2014b) and lower psychological well-being (Riva et al., 2014a), with associations being stronger in women. Inuit women, like other women in many societies, occupy central roles within families and communities. Important topics raised by Inuit women regarding their health and well-being relate to family life, including raising children, caregiving for aging parents, balance of work and family, and family food security (Healey & Meadows, 2007). Historically, following traditional livelihoods, Inuit men and women had distinct but complementary roles. While men had primary authority outside the home, women had more power inside the home. Women took charge of childrearing, preparing food and water, keeping the shelter warm and clean, making clothes, boots, and preparing skins for various functions (Pauktuutit Inuit Women of Canada, 2006). Although there is cooperation between many husbands and wives, with the introduction of the wage economy and social assistance, traditional lines of authority have blurred and gender roles have changed (Pauktuutit Inuit Women of Canada, 2006; Quintal-Marineau, 2017). Arguably, the roles of women have not only changed, but have also expanded. Women are now regularly involved in wage-work and tend to occupy positions that are more permanent than men. Consequently they often assume the responsibility of recurrent payments such as rent, bills, and groceries (Quintal-Marineau, 2019; Saturviit Inuit Women’s Association of Nunavik and Laneuville, 2015). For some women, the transition towards a mixed economy has led to forms of empowerment, providing more freedom of choice, more autonomy. However, the restructuration of work has also placed considerable stress on women, since kinship obligations imply that resources obtained through salaries have to be shared (Quintal-Marineau & Wenzel, in press). It has to be said that men, like in the Canadian society as a whole, are also assuming new roles in the household, although not to equality yet (Pauktuutit Inuit Women of Canada, 2006; Quintal-Marineau, 2016). Men may also be differently impacted by the changes that have accompanied community development and economic inclusion in the State. Women now carry responsibilities related to wage-labour, in addition to their traditional domestic responsibilities. Roles attached to family life are particularly important for women’s identity: ‘in order to be an Inuk woman, one has to raise kids’ [from one participant’s interview in: (Quintal-Marineau, 2016; Quintal-Marineau & Wenzel, in press)]. Being a mother and being able to care for a child is a source of cultural power. Being committed to the family, keeping the community strong, is valued and perceived as a feminine strength (Pauktuutit Inuit Women of Canada, 2017; Saturviit Inuit Women’s Association of Nunavik and Laneuville, 2015). This strength translates into a gendered reality of parenting, in which women are more likely to be the primary caregiver, as exemplified by data from the 2016 Census reporting that 21% of Inuit children in Canada aged 0–4 years were living with a woman lone-parent2; (vs. 6% with a man lone-parent) (Statistics Canada, 2017c). Building on Neale’s(2017) conceptualization of sense of home as an identity-making process, we can assume that fulfilling expectations regarding women’srolesisa HOUSING STUDIES 17 foundational part of home-making practices (making oneself at home). The connections between sense of home, women’s identity, and their expanding roles in modern economy, provide insights into why women seem more importantly affected by overcrowding. Even though there is no doubt that overcrowding is affecting both men and women, overcrowding impacts life spheres that typically come under the responsibility of women. Morepeopleinahouseholdmeansmorepeopletofeed,tosupport,tocarefor. Our results support these arguments: fewer women reported positive perceptions of several house-related PSF in situation of overcrowding, and sense of home was, overall, significantly lower among women compared to men. The positive association between ‘being able to save money’ and sense of home, only observed in women, is in coherence with women increasingly being the main monetary providers. Altogether, these findings show that women are impacted differently than men by overcrowding, and suggest that expanding work and family-related women’s roles may be an important contributor to the less positive perceptions women have of their home environment. Following this reasoning, reduced sense of home may also be an important mechanism linking – or exacerbating the relationship between – overcrowding and reduced well-being in women.

Limitations This study is a cross-sectional analysis, and thus causal relationship between overcrowding and PSF cannot be inferred from the results. The sample used for analysis is constituted of people who were on the waitlist for social housing at the time of recruitment. It is not representative of the population of Nunavik or Nunavut, and any interpretation of these results should take this in consideration. When building the index used in the regressions, certain PSF had to be included on an ad hoc basis, since no tests could be used to determine which ones were the most relevant. A sens- ibility analysis was performed with an alternative 8-item PSF score (Supporting Information Table S1), and regression results did not significantly differ from the ones presented here.

Conclusion To the best of our knowledge, sense of home among Indigenous Peoples has been explored mostly in urban settings, or in the context of homelessness in Canada, and studies have highlighted the relational ontology of Indigenous sense of home (Alaazi et al., 2015;Christensen,2016; Neale, 2017). ‘Feeling at home’, from an Indigenous perspective, has been described as a matter of connecting a community together; a practice centered around visiting family and constantly reaffirming the connection to people, and to the culture (Alaazi et al., 2015; Christensen, 2016; Neale, 2017). In a study exploring the ways Inuit women have been adapting to the shift from vernacular dwellings (igluit) to social housing, Collignon (2001) depicts how the forced sedentarization and the collateral dras- tic change in residential spaces have modified the Inuit culture and identities (Collignon, 2001). Inuit women were aged between 60 and 85 at the time of Collignon’sstudy,they all gave birth to their children in a tent or an igloo, and all had transitioned into living in 18 K. PERREAULT ET AL. permanent housing. Essentially, the life in traditional dwellings was characterized by more porous boundaries and a more fluid relationship to the land, contrasting with the western vision of individual properties with the function of delimitating private spaces. There was also the notion of constant mobility attached to the traditional Inuit ways of living, not only in the physical sense of it (as they were nomadic people), but in terms of sharing food, exchanging knowledge, and building evolving networks of relationships. Ultimately, the segmentation of space, between the land and the houses, between houses within the community, and even within the house itself, has affected visits, sharing practices, communication, and therefore the relational ontology of home in the Inuit culture (Collignon, 2001). Altogether, insights on sense of home suggest that PSF reflecting relational and cultural aspects of the residential space might be particularly relevant to examine. They also point to historical and political influences attached to the Inuit experiences of housing. The current situation of overcrowding experienced by many families in Nunavut and Nunavik is a direct consequence of colonial practices and decisions made by the State regarding Northern housing policies (Tester, 2006, 2009). It is important to recognize how ‘modern’ construc- tions impacted principles at the core of Inuit culture, such as social connection and porosity between ‘internal’ (home) and ‘external’ (the land) spaces (Collignon, 2001). It helps to understand why indicators of physical density like the one used in this study (>1 PPR), when considered in the context of static and imposed permanent settlements, are negatively associated with PSF related to identity (house reflects who I am), domestic relationships (I get along with people in the house), control (I do what I want in the house), and the use of space in relation to activities with strong cultural meanings (kitchen big enough to prepare and cook food for family). Means of promoting sense of home, juxtaposed to overcrowding alleviation strategies, may be powerful elements to consider in the discussions around Northern housing policy.

Notes 1. The Canadian Constitution recognizes three distinct groups of Indigenous Peoples: First Nations, Inuit and Metis. These are three distinct groups of Peoples, with unique histories, languages, cultural practices and spiritual beliefs (https://www.rcaanc-cirnac.gc. ca/eng/1100100013785/1529102490303). 2. It is important to note that other relatives, for example grandparents or other extended family members, may be present in the household of children. Living in a lone-parent family does not imply living with only one parent, and therefore does not exclude overcrowding. It only means that one of the two parents has the primary responsibility of the child.

Acknowledgments The authors wishes to acknowledge partner organizations for their invaluable implication in this project. In Nunavik: Kativik Municipal Housing Bureau, Nunavik Regional Board of Health and Social Services, Kativik Regional Government, and Societed’Habitation du Quebec. In Nunavut: Nunavut Housing Corporation, Government of Nunavut Department of Health, and Nunavut Tunngavik Incorporated. We recognize the important collaboration of Inuit research assistants, local housing committees and managers, and mayors without whom this study would not have been possible. We thank Nunavimmiut and Nunavummiut who generously gave their time to HOUSING STUDIES 19 participate in the project. Finally we wish to acknowledge the contribution of other co-researchers on this project, and the contribution of research assistants who collected data.

Disclosure statement No potential conflict of interest was reported by the authors.

Funding The project Housing, health and well-being in the Arctic received financial support from the Canadian Institutes of Health Research (# GIR-134230) and from ArcticNet - a Network of Centres of Excellence of Canada. Karine Perreault is supported by a Doctoral Research Award from the Canadian Institutes of Health Research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program.

Notes on contributors Karine Perreault is a PhD candidate in Public Health at University of Montreal, Montreal, Canada. Mylene Riva is Canada Research Chair in Housing, Community and Health. She is Assistant Professor at McGill University, in Montreal, Canada, cross-appointed to the Institute for Health and Social Policy and the Department of Geography. Philippe Dufresne is a research assistant at McGill University, Montreal, Canada. Christopher Fletcher is Full Professor in the Department of Social and Preventive Medicine at Universite Laval, Quebec City, Canada.

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