The place may look the same as it has for so long: Tattered and grimy, full of people who have hit bottom with no place to go until their illnesses, addictions and miserable living conditions catch up to them.

And things could get worse, if we're not careful. The Pivot Legal Society has estimated Vancouver's homeless population will nearly triple to 3,200 by the end of the decade unless housing and other needs are addressed.

Nevertheless, a foundation for a healthier community is slowly rising. Some of the visible signs are the construction work on the old Woodward's site, and a few nearby buildings that are getting facelifts.

The best sign is that various levels of government are committing, or are close to committing, significant resources to tackle the fundamental problems.

A review of accomplishments and the challenges that remain is in order.

Housing: The province has bought 10 Single Room Occupancy hotels in the area to preserve the rooms and in many cases upgrade them. More is promised, and that will help.

Housing Minister Rich Coleman and some Vancouver councillors are squabbling over a Winter Games-related goal of building 800 new low-cost housing units a year. They should get their heads together and make sure as many as possible are built.

The province has increased Emergency Shelter Program funding to create more full-time and cold-weather beds.

City council is examining a housing strategy proposal that would see new housing built and residential hotel rooms upgraded. It needs the co-operation of other levels of government.

Council will also be considering an innovative plan to allow a private company to redevelop the Little Mountain social housing site with significantly increased density as a way of extracting funding for new social housing elsewhere.

Social assistance: The province boosted social assistance by $100 a month this year, a long overdue increase, but not enough. The shelter portion is up $50 to $375, but very few rooms can be had for that price. It needs further review.

Social assistance eligibility rules put in place in 2002 are thought to have put many more people on the streets. They should be reviewed and simplified. Bureaucratic mazes should not be used to filter out disadvantaged people who need help.

Psychiatric patients: People who would have been institutionalized until 20 to 30 years ago form a large part of the homeless and addicted population. Promises to provide adequate community-based services when they were deinstitutionalized were broken, and some of them are literally dying on the streets.

The province has funded more affordable housing and emergency shelters; income assistance rates for people with disabilities have gone up; and the premier has created a task force on homelessness, mental illness and addiction. But staff in the health ministry's mental health division have been cut substantially and the government has gotten rid of its mental health advocate, minister of state for mental health and advisory council of mental health.

This legacy is largely a provincial responsibility. It requires urgent attention. Everything from finally providing them with effective community-based services to re-institutionalizing the most seriously ill should be considered.

Four pillars: To really fight drug addiction, we need all four pillars -- prevention, enforcement, harm reduction and treatment. So far we really have only two -- enforcement and harm reduction -- and more than 70 per cent of all funding goes to enforcement. That has to change.

The federal Conservatives need to remove their ideological blinkers. They are understandably uncomfortable with anything that appears to condone drug use, but intellectual honesty dictates they look beyond their prejudices.

There, they will find that the Downtown Eastside's Insite supervised injection site is saving lives and channeling addicts into treatment, and that there is enough evidence to warrant an experiment to provide alternative drug treatment for cocaine and crystal meth addicts.

Those are the broad strokes. Granted, a city the size of Vancouver will always have its share of the kind of problems that haunt the Downtown Eastside. But that share remains far too large.