In July of 2023, the BC Minister for Housing, Ravi Kahlon, pointed out that the province has 17 communities with populations of 80,000-plus, and that all 17 will be asked “to play a bigger role” in accommodating British Columbia’s population growth. It can be assumed that this means that these communities will be responsible for building more homes and that due to their growth, these cities will also need to play a bigger role in preventing and ending homelessness. For example, as Nanaimo has grown, we are seeing ongoing increases in homelessness. Based on this example, it’s likely that all medium-sized communities across Canada will face the same pressures that we have seen in Nanaimo with regard to population growth and increases in homelessness.  

According to Nanaimo’s Housing Needs Assessment Report, an average of 1115 housing units must be built by 2031 to meet local population growth. The same report shows that this is consistent with recent trends in housing units being built in Nanaimo. It is important to highlight that this number does not include units designed to house those who are or may become unhoused. While many communities are building thousands of housing units, like Nanaimo, they are not building enough affordable housing, non-market, or rental housing to meet the demands created by population growth and those currently unhoused or at risk of becoming unhoused.

Historically, there has been a limited focus on ‘medium-sized’ communities in the homelessness sector but our project and this blog aim to shed some light on the potential that exists in this understudied area. Specifically, our project brings attention to the unique strengths and structural properties that enable medium-sized cities to address homelessness in ways that are significantly different from large urban cities in Canada. This finding presents an important developmental opportunity for policy and research. 

How Medium-Sized Cities Approach Connectivity Among Service Providers and Agencies

We would argue that most sector policy frameworks have been developed for large urban centres with a distinct focus on enhancing connections between agencies. Our research highlights the fact that this is a pre-existing characteristic of medium-sized communities. In other words, connections between agencies tend to develop organically in well-functioning medium-sized urban centres. For example, in Nanaimo the implementation of ‘Coordinated Access’ (CA) has merit, and it reinforces the community service provider and agency relationships that already exist. However, in this case, CA built on rather than created agency connections. As one local Executive Director said, “We have a coordinated system, it’s just not up to standards”.

This interpretation opens the door to considerations of the expectations of scalability. While many housing and homelessness interventions are framed as ‘scalable’, they assume that merely adding or subtracting various policies is straightforward. It has been our observation that the connections/foundations already exist, and the challenge lies in scaling the resources up to match the needs of communities- which isn’t as straightforward to do as many people may assume.

“…there are simply too many notes, that’s all. Just cut a few and it will be perfect.” - Emperor Joseph II in the film Amadeus (1984)

Based on our research in Nanaimo, about 80-90% of all the housing and homelessness support work is done by a relatively small number of agencies (approximately 10 -12) and all the staff at each agency know almost everyone by name. The strong relationships formed through long-term and ongoing interaction with shared clientele display an already high level of coordination. So much so that in Nanaimo almost everyone who works with vulnerable populations can usually quickly and accurately identify a given individual based on a few features of their case history or identity. This is a remarkable accomplishment given that this community contains at the very least 500 unhoused community members and it can be assumed that this is likely the case in other medium-sized cities based on conversations we have had with various sector staff in similarly sized locales.

The issue a medium-sized community like Nanaimo faces is not a lack of service connectivity or enhanced coordination. What it and other medium-sized communities need is resources to adequately address the sheer scale of the challenges that its small number of social service sector agencies, and city staff face. While efficiency can always be improved, the unique features of their existing forms of coordination help medium-sized communities to more effectively prevent and end homelessness. 

These features of medium-sized communities’ interventions are worth a closer look, and we hope that our presentation will serve as a starting point for this important conversation. The aim is to stimulate a nationwide conversation about the nature of service delivery in medium-sized communities that will inform both local service delivery and policy considerations.

The frontline and administrative staff we spoke with who work in the housing and homelessness support and service sector believe that there are unique strengths and capabilities that enable ‘Nanaimo-sized’ communities to find solutions. It was suggested by one staff member that these cities are big enough to meet the challenges, but not so big that they are overwhelmed by the sheer number of agencies and staff. 

“It's not like Calgary where they are dealing with 3,000 inter-agency referrals on a regular basis.” – Sector commentator

Our presentation will yield specific insights about homelessness that are rarely, if ever, reflected in current policy and research. These insights will have direct implications for transforming the shape of interventions to address the needs of all medium-sized cities in Canada.

If you’d like to be part of this conversation, join us at our presentation Medium Sized Communities transformative interventions in homelessness: Initiating A National Dialogue on Thursday, November 9th, at 10:00 am at the CAEH23 Conference as we initiate this important nationwide dialogue.

Feel free to reach out before, during, or after the conference:


This post is part of our #CAEH23 blog series which highlights research on preventing and ending homelessness that is being presented at the 2023 National Conference on Ending Homelessness, November 8-10 in Halifax, NS. Learn more about the authors’ work through their presentation in the Medium Sized Communities transformative interventions in homelessness: Initiating A National Dialogue on Thursday, November 9th, at 10:00 am